International Consensus Guideline on Small for Gestational Age: Etiology and Management From Infancy to Early Adulthood

Abstract

This International Consensus Guideline was developed by experts in the field of SGA of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Besides, it presents long-term consequences of SGA birth and new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, and the metabolic and cardiovascular health of young adults born SGA after cessation of childhood-GH-treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardio-metabolic health profile in adulthood. Children born SGA with persistent short stature < -2.5 SDS at age 2 years or < -2 SDS at age of 3-4 years, should be referred for diagnostic work-up. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033–0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3-4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle.

Small for gestational age preterm infants and later adiposity and height: A systematic review and meta‐analysis

“…Healthcare providers are unsure how preterm SGA infants should be supported to optimise long-term outcomes. [7][8][9][10][11] Recent evidence indicates that preterm infants born SGA are not at increased risk of developing higher blood pressure as children or as adults as compared to non-SGA preterm infants. 12 Individuals with short stature have smaller body components, on average.…”

“…Healthcare providers are eager to ensure optimal physical and neurological growth for all newborns, particularly those born small for gestational age (SGA) and preterm (<37 weeks). Healthcare providers are unsure how preterm SGA infants should be supported to optimise long‐term outcomes 7–11 . Recent evidence indicates that preterm infants born SGA are not at increased risk of developing higher blood pressure as children or as adults as compared to non‐SGA preterm infants 12 …”

The Genetic Landscape of Children Born Small for Gestational Age with Persistent Short Stature

“…Thus, the currently available reports have their origin in retrospective analysis of children genetically diagnosed at a late stage of their therapy. The currently available data are scarce, as summarised in the latest consensus [36]. In our cohort, the long-term growth data are available only in a minority of children; therefore, we present short-time growth data following 1 year and 3 years of GH administration and, when available, final height SDS.…”

Assessment of Nutritional Status in the Diagnostic Evaluation of the Child with Growth Failure

“…When taking a medical history, most paediatric endocrinologists are more focused on birth size (a cross-sectional indicator) than on longitudinal indicators of intrauterine growth restriction, and it is important to note that these terms are not synonymous. In paediatric endocrine consensus meetings, small for gestational age (SGA) was defined by paediatric endocrinologists as a birth weight and/or length below −2 standard deviation score (SDS) for gestational age and sex [22, 23]. SGA can be caused by maternal health and obstetric factors, placental insufficiency, and foetal (epi)genetic factors [23, 24].…”

“…In paediatric endocrine consensus meetings, small for gestational age (SGA) was defined by paediatric endocrinologists as a birth weight and/or length below −2 standard deviation score (SDS) for gestational age and sex [22, 23]. SGA can be caused by maternal health and obstetric factors, placental insufficiency, and foetal (epi)genetic factors [23, 24]. Approximately 90% of children born SGA show catch-up growth in the first 2–3 years [25] and are usually not referred to a paediatrician for GF.…”