July - September 2007, Volume 3, Issue 3

Popa M

Children born small for gestational age (SGA): a new frontier for GH therapy

Acta Endo (Buc) 2007, 3 (3): 371-382
doi: 10.4183/aeb.2007.371

A 9 member independent panel of endocrinologists and pediatricians was convened to discuss basic issues with respect to definition, diagnosis, and clinical management of children born small for gestational age (SGA). SGA is defined as the situation when birth weight and/or length are at least 2 standard deviations (SD-s) below the mean for gestational age (<2 SD). The seven consensus guidelines agreed by the panel members are as follows: i. Children born SGA have a serious and permanent handicap of growth in adulthood if not treated. ii. Any term newborn lighter than 2500 g (male) or 2000 g (female) may be considered SGA. iii. When 4 years of age, all children born SGA will be evaluated for height, height velocity, bone age. Preterm children and multiplets should be included even if they were AGA. All children having concomitantly a SD score of < -2.5, a HVSD score < -1 and a bone age (Greulich-Pyle) smaller or equal to the chronological age are to be considered candidates to GH therapy. iv. All recognizable short stature syndromes must be extracted from the contingent of SGA by clinical and laboratory thorough evaluation and subjected to their distinctive growth disturbance protocol. v. The rest of candidates will receive GH therapy at 0.35 mg/kg/week daily dosage. A\r\nbiochemical screening including hormonal and IGF I determinations and also hematology should be performed before administering the first injection. GH dynamic tests are not recommended as a rule. vi. Effectiveness of the therapy will be appreciated after 6-12 months of uninterrupted therapy. Annualized growth rates higher than 7 cm/yr are considered proofs in favor of successful therapy. IGF I levels higher than 600 ng/ml should be avoided. vii. After the inclusion in therapy and the first evaluation, the patients follow-up should align to the standard provisions of the national or regional programs of GH therapy.

Keywords: small for gestational age, intrauterine growth retardation, catch-up growth, short stature, growth hormone therapy

Correspondence: Mircea Popa, &#8220;C. I. Parhon&#8221; Institute of Endocrinology, 34-36 Aviatorilor Blvd., 011863 Bucharest, Romania, email growthing@yahoo.com