Babies Born Small (Small for Gestation/SGA) – do they fall short ?

  1. 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.

  2. 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
  3. 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
  4. 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
  5. 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.

  6. 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.

  7. 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!!