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Published on: February 2, 2017
New Horizons in Short Children Born Small for Gestational Age
Irène Netchine1, Manouk van der Steen2, Abel López-Bermejo3
1Sorbonne Université, INSERM, UMR_S938 Centre de Recherche Saint Antoine, APHP, Hôpital Armand Trousseau, Explorations Fonctionnelles Endocriniennes, Paris, France.
Insights
Children born small for gestational age (SGA) who remain short may benefit from growth hormone (GH) treatment for linear growth and metabolic improvements. Post-treatment monitoring is crucial for body composition and metabolic changes.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Growth Medicine
Background:
- Children born small for gestational age (SGA) are a diverse group with varied causes for their size.
- Most SGA children experience catch-up growth, but some remain short and face risks of metabolic issues and pubertal disturbances.
- The 360° European Meeting on Growth and Endocrine Disorders focused on short SGA children, their treatment, and associated conditions like Silver-Russell syndrome.
Purpose of the Study:
- To review the management of short children born small for gestational age (SGA).
- To discuss the efficacy and long-term effects of growth hormone (GH) treatment in SGA children.
- To examine emerging treatment strategies for optimizing adult height and metabolic health in SGA populations.
Main Methods:
- Review of presentations and discussions from the 360° European Meeting on Growth and Endocrine Disorders.
- Analysis of current guidelines for diagnosing and managing SGA and Silver-Russell syndrome.
- Evaluation of evidence for growth hormone (GH) therapy and potential pubertal delay treatments.
Main Results:
- Growth hormone (GH) treatment is approved for short SGA children, improving linear growth and some metabolic parameters.
- While GH therapy shows benefits, metabolic normalization after cessation is incomplete, necessitating ongoing monitoring.
- Children with Silver-Russell syndrome require early GH treatment initiation due to limited catch-up growth potential.
Conclusions:
- GH treatment offers significant benefits for short SGA children, but long-term metabolic and body composition monitoring is essential after cessation.
- Early intervention is critical for SGA children, particularly those with Silver-Russell syndrome, to maximize growth potential.
- Off-label treatments to delay puberty in SGA children require further research to establish efficacy and safety.
Abstract:
Children born small for gestational age (SGA) comprise a heterogeneous group due to the varied nature of the cause. Approximately 85-90% have catch-up growth within the first 4 postnatal years, while the remainder remain short. In later life, children born SGA have an increased risk to develop metabolic abnormalities, including visceral adiposity, insulin resistance, and cardiovascular problems, and may have impaired pubertal onset and growth. The third "360° European Meeting on Growth and Endocrine Disorders" in Rome, Italy, in February 2018, funded by Merck KGaA, Germany, included a session that examined aspects of short children born SGA, with three presentations followed by a discussion period, on which this report is based. Children born SGA who remain short are eligible for GH treatment, which is an approved indication. GH treatment increases linear growth and can also improve some metabolic abnormalities. After stopping GH at near-adult height, metabolic parameters normalize, but pharmacological effects on lean body mass and fat mass are lost; continued monitoring of body composition and metabolic changes may be necessary. Guidelines have been published on diagnosis and management of children with Silver-Russell syndrome, who comprise a specific group of those born SGA; these children rarely have catch-up growth and GH treatment initiation as early as possible is recommended. Early and moderate pubertal growth spurt can occur in children born SGA, including those with Silver-Russell syndrome, and reduce adult height. Treatments that delay puberty, specifically metformin and gonadotropin releasing hormone analogs in combination with GH, have been proposed, but are used off-label, currently lack replication of data, and require further studies of efficacy and safety.
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