Growth hormone treatment in small for gestational age children. A single-center experience

Area of Science:

• Pediatric Endocrinology
• Growth Disorders
• Neonatal Medicine

Background:

• Small for gestational age (SGA) is defined by anthropometric characteristics at birth, typically resulting in a final height 1 standard deviation (SD) below the mean.
• SGA is categorized into low birth weight (LBW), short birth length (SBL), or both, influencing growth trajectories.
• Catch-up growth is a critical factor in determining the need for intervention in SGA children.

Purpose of the Study:

• To characterize patients diagnosed with SGA at a tertiary care pediatric endocrinology department.
• To analyze the growth hormone (GH) treatment response in SGA children lacking spontaneous catch-up growth by age four, stratified by diagnostic group (LBW, SBL, or both).

Main Methods:

• A retrospective study was conducted on 89 SGA patients diagnosed and managed between 2004 and 2021.
• Patient data included anthropometric measurements at birth, diagnosis, and final height.
• Growth hormone (GH) treatment outcomes were analyzed for 44 SGA patients who did not achieve catch-up growth by age four.

Main Results:

• SGA patients diagnosed by both LBW and SBL exhibited the lowest height percentiles at diagnosis (-3.17 SD) and demonstrated the most significant response to GH therapy, with a final height gain of 1.93 SD.
• Children with LBW (-2.99 SD) and SBL (-2.85 SD) also showed substantial height gains (1.22 SD and 1.33 SD, respectively) with GH treatment, reaching near target heights.
• Less than half of referred SGA children required GH treatment, indicating that age and catch-up growth status are key determinants for intervention.

Conclusions:

• SGA children with specific birth characteristics (LBW and/or SBL) present with more severe growth deficits at diagnosis.
• These SGA subgroups exhibit a pronounced positive response to growth hormone (GH) therapy, leading to significant height improvement.
• GH treatment is a valuable therapeutic option for SGA children who do not achieve adequate catch-up growth, particularly those with combined LBW and SBL.