- Who are SGA babies ?
The term small for gestational age (SGA) describes a child who is small for weight or
length at birth (which is more than 2 standard deviations below the mean
(<– 2 SD) or below the 3rd percentile for the population. - What causes SGA ?
There are many causes which can result in an SGA baby –
Fetal causes
- Chromosomal or other genetic defects
- Congenital anomalies
- Intra-uterine infection
- Multiple gestation
Maternal causes
- Medical conditions
- Pregnancy pathology
- Ethnicity (Indian/Asian)
- Short stature
- Low weight/malnutrition
- Age (<16 or >35 years)
- Substance abuse
Environmental factors
- High altitude
- Toxic substances
- Air pollution
- Consequences of being born SGA : why is SGA a concern?
The outcomes in SGA babies can be short term or long term
Short-term SGA consequences- Hypoglycemia- Around one in three may become hypoglycaemic after birth
- Thermoregulation difficulties-Difficulty to maintain body temperature vs AGA counterparts
- Haematological effects-Excessive red cell production and decreased platelets, Thrombocytopenia is found in >50% of SGA infants than in infants born AGA
- Difficult to adapt after delivery – Breathing difficulty, lack of breast feeding etc.
Long-term SGA consequences
- Growth related- Children born SGA have a higher risk of short stature than those born appropriate for age. ~90% catch up during the first 2 years of life. However Children born SGA who do not catch up in height account for about 10% of all short adults.
- They have high risk of Increased fat mass, Decreased bone mineral density.
- Later in life they have higher chance of Cardiovascular complications, Obstructive pulmonary disease, Type 2 diabetes mellitus, Renal insufficiency, Impaired reproductive functions
- How should Monitoring growth in children born SGA be done ?
The International Societies of Pediatric Endocrinology and the Growth Hormone
Research Society both recommend early monitoring of these children to pick up any
lag in the catch-up growth that may happen leading to decreased adult height if
missed.Measurements of length, weight, and head circumference
- Every 3 months for the first year,
- Then every 6 months
- Is there treatment for short stature in such children ?
Yes, SGA babies who do not catch up by 4 years of age should be evaluated by a Pediatric Endocrinologist and initiated on growth hormone therapy depending on the evaluation results.
- How does Growth Hormone help ?
The main objectives of GH therapy in short children born SGA are:
- To accelerate linear growth in early childhood
- To achieve rapid catch-up growth
- To maintain normal growth later in childhood
The ultimate objective of treatment is to help the child achieve adult height within normal target range.
- Is growth hormone safe in children ?
Yes the efficacy of growth hormone has been evaluated by FDA and advocated for short SGA children.
I have published a study of result of growth hormone in SGA children with the following results:
[http://www.remedypublications.com/open-access/growth-hormone-outcomes-in-rss-and-sga-children-indian-tertiary-care-study-4462.pdf]- A significant height improvement occurred in both RSS and SGA children after 1year of GH treatment.
- There were no significant side effects noted in during this period.
- Children initiated at age less than 8 yrs fared marginally better than when started at a later age group.
It is time to improve the standard of care of Small for Gestational Age (SGA) in India!!
