Growth hormone treatment for small for gestational age children

Children born small for gestational age (SGA) represent a heterogeneous population with an increased risk of persistent short stature and adverse metabolic outcomes later in life. Although most SGA infants exhibit spontaneous catch-up growth during early childhood, approximately 10-15% fail to do so and remain short as adults. Growth hormone (GH) therapy has been used for several decades in this subgroup and is currently approved in many countries worldwide. This review summarizes the biological rationale for GH treatment in SGA children, current indications for therapy, and differences among international guidelines regarding age at initiation and dosing strategies. Available evidence on growth response, predictors of treatment efficacy, and expected gains in near-adult height is discussed, together with data on safety and metabolic monitoring. Particular attention is given to the importance of early treatment initiation, individualized dose adjustment, and sustained therapy through the prepubertal years. The response to GH in syndromic forms of SGA, including Silver-Russell syndrome, is also reviewed. Finally, emerging data on long-acting GH formulations are briefly addressed, highlighting current knowledge gaps and the need for long-term outcome studies.