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

Anita C S Hokken-Koelega1, Manouk van der Steen1, Margaret C S Boguszewski2

  • 1Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands.

Endocrine Reviews
|January 13, 2023
PubMed

Insights

This guideline offers updated insights into small for gestational age (SGA) causes and consequences. It recommends growth hormone (GH) therapy and gonadotropin-releasing hormone agonist (GnRHa) for persistent short stature in SGA children.

Area of Science:

  • Pediatric Endocrinology
  • Genetics
  • Growth Disorders

Background:

  • Small for gestational age (SGA) affects children's growth and long-term health.
  • Understanding the etiology and consequences of SGA is crucial for timely intervention.
  • Existing guidelines require updates based on new research in genetics and treatment.

Purpose of the Study:

  • To provide an international consensus guideline on the diagnosis, management, and long-term outcomes of SGA.
  • To incorporate novel insights into the (epi)genetic causes of short stature in SGA individuals.
  • To review updated treatment options, including growth hormone (GH) and gonadotropin-releasing hormone agonist (GnRHa), and assess metabolic/cardiovascular health post-treatment.

Main Methods:

  • Development of a consensus guideline by 10 pediatric endocrine societies.
  • Systematic review and discussion of 1300 relevant articles.
  • Expert voting on the strength of recommendations.

Main Results:

  • Accurate anthropometry and national growth charts are recommended for SGA diagnosis.
  • Early follow-up and neurodevelopmental evaluation are warranted for at-risk infants.
  • Persistent short stature (< -2.5 SDS at 2 years or < -2 SDS at 3-4 years) warrants workup.
  • Genetic testing is advised for SGA children with dysmorphic features or developmental delays.
  • GH treatment (0.033-0.067 mg/kg/day) is recommended for persistent short stature at 3-4 years.
  • GnRHa may be considered alongside GH for predicted short adult height.
  • Avoiding excessive postnatal weight gain is critical for long-term cardiometabolic health.
  • Long-term follow-up of metabolic and cardiovascular health in SGA adults is essential.

Conclusions:

  • This guideline provides evidence-based recommendations for managing SGA children.
  • It emphasizes early diagnosis, appropriate interventions like GH and GnRHa, and long-term health monitoring.
  • Promoting healthy lifestyles is crucial for young adults born SGA to mitigate health risks.

Keywords:
GHSGAconsequencesetiologygeneticsmanagement

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