International Small for Gestational Age Advisory Board Consensus Development Conference Statement: Management of Short Children Born Small for Gestational Age, April 24–October 1, 2001

Abstract

SGA is defined as birth weight and/or length at least 2 standard deviations (SDs) below the mean for gestational age (<or=-2 SD). Accurate gestational dating and measurement of birth weight and length are crucial for identifying children who are born SGA. Comprehensive pregnancy, perinatal, and immediate postnatal data may help to confirm the diagnosis. Maternal, placental, and fetal causes of SGA should be sought, although the cause is often not clear. Most children who are SGA experience catch-up growth and achieve a height >2 SD below the mean; this catch-up process is usually completed by the time they are 2 years of age. A child who is SGA and older than 3 years and has persistent short stature (ie, remaining at least 2 SD below the mean for chronologic age) is not likely to catch up and should be referred to a pediatrician who has expertise in endocrinology. Bone age is not a reliable predictor of height potential in children who are SGA. Nevertheless, a standard evaluation for short stature should be performed. A diagnosis of SGA does not exclude growth hormone (GH) deficiency, and GH assessment should be performed if there is clinical suspicion or biochemical evidence of GH deficiency. At baseline, insulin-like growth factor-I, insulin-like growth factor binding protein-3, fasting insulin, glucose, and lipid levels as well as blood pressure should be measured, and all aspects of SGA-not just stature-should be addressed with parents. The objectives of GH therapy in short children who are SGA are catch-up growth in early childhood, maintenance of normal growth in childhood, and achievement of normal adult height. GH therapy is effective and safe in short children who are born SGA and should be considered in those older than 2 to 3 years. There is long-term experience of improved growth using a dosage range from 0.24 to 0.48 mg/kg/wk. Higher GH doses (0.48 mg/kg/wk [0.2 IU/kg/d]) are more effective for the short term. Whether the higher GH dose is more efficacious than the lower dose in terms of adult height results is not yet known. Only adult height results of randomized dose-response studies will give a definite answer. Monitoring is necessary to ensure safety of medication. Children should be monitored for changes in glucose homeostasis, lipids, and blood pressure during therapy. The frequency and intensity of monitoring will vary depending on risk factors such as family history, obesity, and puberty.

Analysis of fetal growth restriction in pregnancy in subjects attending in an obstetric clinic of a tertiary care teaching hospital

“…1 Small gestational age (SGA) refers to weight below the 10 percentile for gestational age, corrected for parity and gender, as per the population growth charts. It can be further classified as: 2 • Moderate: Birth weight in the 3 to 10 percentiles (or 5th to 10th centile) • Severe: Birth weight less than 3 percentile (or <5th centile)…”

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

“…The literature includes studies on small babies (below 2,500 g at birth), small for gestational age (SGA) babies (birth weight is related to gestational week, sex, and local birth weight references), and fetal growth-restricted babies (in which a previously harmonic growth is impaired by a relevant pathologic event). These definitions partly overlap, but only SGA and growth-restricted babies have a definite pathologic meaning (8)(9)(10)(11)(12)(13).…”

Fetal programming and systemic sclerosis

“…The term small for gestational age (SGA) refers to infants whose birthweights and/ or lengths are at least 2 standard deviation units less than the mean for gestational age. 20 In clinical practice, SGA commonly is defined as a birthweight <10th percentile for gestational age and sex relative to the population standard; it is used as a measurable proxy for intrauterine growth restriction and later health risks. 21 The study population was divided according to birthweight (<2500, !2500, or !4000 g) and gestational age (preterm, <37 weeks; at term, 37-41 weeks; postterm, >41 weeks).…”