Early diagnosis and treatment referral of children born small for gestational age without catch-up growth are critical for optimal growth outcomes

Abstract

Approximately 10% of children born small for their gestational age (SGA) fail to show catch-up growth and may remain short-statured as adults. Despite treatment guidelines for children born SGA that recommend referral for growth hormone (GH) therapy evaluation and initiation by ages 2 to 4 years, the average age of GH treatment initiation is typically much later, at ages 7 to 9 years. Delayed referral for GH treatment is problematic as studies show younger age at GH treatment initiation in children born SGA is an independent predictor for responses such as optimal growth acceleration, normalization of prepubertal height, and most importantly, adult height (AH). This review discusses the importance and associated challenges of early diagnosis of children born SGA who fail to show catch-up growth, contrasts the recommended age of referral for these patients and the average age of GH treatment initiation, and discusses studies showing the significant positive effects of early referral and treatment with GH on AHs in short-statured children born SGA. To optimize the eventual height in short-statured SGA children who fail to manifest catch-up growth, a lowering of the average age of referral for GH therapy evaluation is needed to better align with consensus recommendations for SGA management. The importance of increasing parental and physician awareness that most children born SGA will do well developmentally and will optimally benefit from early initiation of GH treatment when short-statured is addressed, as is the need to shift the age of referral to better align with consensus recommendations.

Short Stature Screening by Accurate Length Measurement in Infants with a Birth Weight <9th Centile

“…However, there is now consensus that, in terms of auxology, the cut-off values for BW and BL should be ≤-2 SDS below the mean [6,16]. The prerequisites for the correct application of these cut-off values are the accurate measurement of gestational age, BW and BL, and appropriate population-specific reference data [9,16]. …”

“…Identifying the cause where possible is recommended [16] as aetiology may affect prognosis and treatment, although approximately 40% of neonates with a BW ≤-2 SDS have no underlying pathology [9]. The definition of small birth size has been a subject of debate, with differing thresholds for neonatal care and endocrine evaluation.…”

“…In keeping with national policy, this unit identifies all newborns with a BW ≤9th centile, using Child Growth Foundation charts [8], and pays particular attention to feeding and blood glucose monitoring in these infants. Gestational age was assessed by dates and ultrasound scanning at 12-14 weeks as recommended for the diagnosis of IUGR and short stature [9]. …”

Restricción del crecimiento intrauterino: perspectiva endocrinológica. Resumen

“…Estudios recientes recomiendan iniciarlo a edades tempranas, entre los 2 y los 4 años, para lograr una mayor aceleración de la velocidad de crecimiento, normalización de la talla en edad prepuberal, mayor talla de inicio puberal y mayor talla adulta. 31,32 Sin embargo, los criterios adoptados por la FDA, la EMEA y el Ministerio de Salud de nuestro país varían con respecto a la edad de inicio del tratamiento. Por esta razón, hay que tener en cuenta las características individuales del paciente para determinar la edad de inicio de tratamiento, en especial, cuando la talla y la velocidad de crecimiento se ven muy afectados a edades más tempranas.…”

“…Las dosis habitualmente utilizadas son mayores que las recomendadas en niños con deficiencia de HC y la modalidad sugerida es el tratamiento continuo. 30,31 Durante el tratamiento, deben controlarse la respuesta del crecimiento, la tensión arterial, los niveles de IGF1, insulina y glucemia en ayunas.…”