{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T22:58:28Z","timestamp":1768345108784,"version":"3.49.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Children born small for gestational age (SGA) are at increased risk for impaired growth, metabolic disturbances, and neurodevelopmental difficulties. Although previous research has examined cognitive and behavioral outcomes in this population, findings remain inconsistent. Moreover, limited evidence is available regarding the potential effects of recombinant human growth hormone (rhGH) therapy on cognitive development. We aimed to assess cognitive performance, emotional\u2013behavioral functioning, and neonatal predictors of neurocognitive outcomes in term SGA children compared with age- and sex-matched peers born appropriate for gestational age (AGA). We also explored potential differences in cognitive outcomes between rhGH-treated and untreated SGA children. Methods: A total of 18 term SGA children and 23 AGA controls underwent anthropometric measurements, biochemical evaluation, cognitive testing using the Wechsler Intelligence Scale for Children\u2014Fourth Edition (WISC-IV), and behavioral assessment through the Child Behavior Checklist (CBCL). Birth weight, length, and head circumference were analyzed as potential predictors of cognitive performance. Results: SGA children demonstrated significantly lower Intelligence Quotient (IQ) scores than AGA peers, with marked weaknesses in Perceptual Reasoning index (PRI) and Processing Speed index (PSI), while Verbal Comprehension and Working Memory were preserved. They also exhibited higher internalizing behavioral symptoms, whereas externalizing behaviors did not differ between groups. Birth head circumference emerged as a strong predictor of PRI and a modest predictor of PSI. No associations were found between rhGH treatment parameters and cognitive outcomes. Larger longitudinal studies are needed to clarify how early growth restriction affects brain development and cognition and whether GH therapy influences these processes.<\/jats:p>","DOI":"10.3390\/children13010120","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T15:52:57Z","timestamp":1768319577000},"page":"120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Behavioral and Cognitive Assessment in a Cohort of Term Small-for-Gestational-Age Children"],"prefix":"10.3390","volume":"13","author":[{"given":"Rossella","family":"Vitale","sequence":"first","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annachiara","family":"Libraro","sequence":"additional","affiliation":[{"name":"Department of Translational Biomedicine and Neuroscience, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Cocciolo","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariangela","family":"Chiarito","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7541-0616","authenticated-orcid":false,"given":"Emilia","family":"Matera","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1899-8337","authenticated-orcid":false,"given":"Maria Felicia","family":"Faienza","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1210\/endrev\/bnad002","article-title":"International Consensus Guideline on Small for Gestational Age: Etiology and Management from Infancy to Early Adulthood","volume":"44","author":"Boguszewski","year":"2023","journal-title":"Endocr. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1253\/circj.CJ-15-1038","article-title":"Vascular Function and Myocardial Performance Indices in Children Born Small for Gestational Age","volume":"80","author":"Faienza","year":"2016","journal-title":"Circ. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1111\/ijpo.12439","article-title":"Pilot study on circulating miRNA signature in children with obesity born small for gestational age and appropriate for gestational age","volume":"13","author":"Marzano","year":"2018","journal-title":"Pediatr. Obes."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1159\/000347217","article-title":"Nonalcoholic fatty liver disease in prepubertal children born small for gestational age: Influence of rapid weight catch-up growth","volume":"79","author":"Faienza","year":"2013","journal-title":"Horm. Res. Paediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1159\/000530521","article-title":"The Genetic Landscape of Children Born Small for Gestational Age with Persistent Short Stature","volume":"97","author":"Toni","year":"2024","journal-title":"Horm. Res. Paediatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.earlhumdev.2017.04.016","article-title":"Long-term attention deficits combined with subcortical and cortical structural central nervous system alterations in young adults born small for gestational age","volume":"110","author":"Suffren","year":"2017","journal-title":"Early Hum. Dev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"210.e1","DOI":"10.1016\/j.ajog.2015.04.011","article-title":"Brain metabolite differences in one-year-old infants born small at term and association with neurodevelopmental outcome","volume":"213","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/uog.12391","article-title":"Neurodevelopmental outcome of full-term small-for-gestational-age infants with normal placental function","volume":"42","author":"Savchev","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1007\/s00431-008-0913-9","article-title":"Determinants of cognitive ability at 7 years: A longitudinal case\u2013control study of children born small-for-gestational-age at term","volume":"168","author":"Theodore","year":"2009","journal-title":"Eur. J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"F197","DOI":"10.1136\/archdischild-2016-310791","article-title":"Thin-for-gestational-age infants are at increased risk of neurodevelopmental delay at 2 years","volume":"102","author":"Hannon","year":"2017","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1001\/jamapediatrics.2020.1097","article-title":"Association of intrauterine growth restriction and small for gestational age status with childhood cognitive outcomes: A systematic review and meta-analysis","volume":"174","author":"Sacchi","year":"2020","journal-title":"JAMA Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/ppe.12468","article-title":"Early postnatal growth and neurodevelopment in children born moderately preterm or small for gestational age at term: A systematic review","volume":"32","author":"Taine","year":"2018","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.jpeds.2014.11.043","article-title":"Functional outcomes at age 7 years of moderate preterm and full-term children born small for gestational age","volume":"166","author":"Tanis","year":"2015","journal-title":"J. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3702","DOI":"10.1038\/s41598-025-86241-2","article-title":"Executive functions in adults born small for gestational age at term: A prospective cohort study","volume":"15","author":"Aakvik","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_15","first-page":"e2021049","article-title":"Evidence of changes in the oral language in children born full-term and small for gestational age: A systematic review","volume":"40","author":"Rios","year":"2022","journal-title":"Rev. Paul. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1007\/s10995-023-03760-y","article-title":"Small-for-gestational-age and vocabulary and achievement test scores at age 9 among children born at term","volume":"27","author":"Reichman","year":"2023","journal-title":"Matern. Child Health J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.mehy.2006.08.004","article-title":"Auditory processing deficits in growth-restricted fetuses affect later language development","volume":"68","author":"Kisilevsky","year":"2007","journal-title":"Med. Hypotheses"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"414","DOI":"10.3345\/kjp.2016.59.10.414","article-title":"Behavioral and intelligence outcome in 8- to 16-year-old born small for gestational age","volume":"59","author":"Yi","year":"2016","journal-title":"Korean J. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/MPG.0b013e3181da213e","article-title":"Neonatal Anthropometric Charts: The Italian Neonatal Study Compared with Other European Studies","volume":"51","author":"Bertino","year":"2010","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/BF03344156","article-title":"Italian Cross-Sectional Growth Charts for Height, Weight and BMI (2 to 20 yr)","volume":"29","author":"Cacciari","year":"2006","journal-title":"J. Endocrinol. Investig."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/j.1753-4887.1981.tb06734.x","article-title":"Growth and Maturation During Adolescence","volume":"39","author":"Tanner","year":"1981","journal-title":"Nutr. Rev."},{"key":"ref_22","unstructured":"Orsini, A., Pezzuti, L., and Picone, L. (2011). WISC-IV: Contributo Alla Taratura Italiana, Giunti O.S."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5296\/jsss.v8i2.18166","article-title":"Exploring the Validity and Reliability of the WISC-IV: A Review of the Literature","volume":"8","author":"Andrikopoulos","year":"2021","journal-title":"J. Soc. Sci. Stud."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kreutzer, J.S., DeLuca, J., and Caplan, B. (2011). Child Behavior Checklist. Encyclopedia of Clinical Neuropsychology, Springer.","DOI":"10.1007\/978-0-387-79948-3"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1111\/1471-0528.16341","article-title":"Small for Gestational Age\u2014Cognitive Performance from Infancy to Adulthood: An Observational Study","volume":"127","author":"Eves","year":"2020","journal-title":"BJOG"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"De Bie, H.M.A., Oostrom, K.J., Boersma, M., Veltman, D.J., Barkhof, F., Delemarre-van de Waal, H.A., and van den Heuvel, M.P. (2011). Global and Regional Differences in Brain Anatomy of Young Children Born Small for Gestational Age. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0024116"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1542\/peds.112.2.301","article-title":"Learning, Cognitive and Attentional Problems in Adolescents Born Small for Gestational Age","volume":"112","author":"Williams","year":"2003","journal-title":"Pediatrics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101247","DOI":"10.1016\/j.lanepe.2025.101247","article-title":"Early-Life Growth and Emotional, Behavioral and Cognitive Outcomes in Childhood and Adolescence in the EU Child Cohort Network: Individual Participant Data Meta-Analysis of Over 109,000 Individuals","volume":"52","author":"Blaauwendraad","year":"2025","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wo\u0142ejszo, S., Genowska, A., Motkowski, R., Strukcinskiene, B., Klukowski, M., and Konstantynowicz, J. (2023). Insights into Prevention of Health Complications in Small for Gestational Age Births in Relation to Maternal Characteristics: A Narrative Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020531"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s12955-022-01948-4","article-title":"Health-Related Quality of Life in Young Adults Born Small for Gestational Age: A Prospective Cohort Study","volume":"20","author":"Mehl","year":"2022","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1017\/S135561771800084X","article-title":"Head Growth and Intelligence from Birth to Adulthood in Very Preterm and Term Born Individuals","volume":"25","author":"Jaekel","year":"2019","journal-title":"J. Int. Neuropsychol. Soc."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T16:13:12Z","timestamp":1768320792000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["children13010120"],"URL":"https:\/\/doi.org\/10.3390\/children13010120","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]}}}