Abstract Ref Number = APCP192
Growth of SGA children: what do we miss?
Muhammad Yazid Jalaludin
Deparment of Paediatrics, Faculty of Medicine, University Malaya
Small for gestational age (SGA) is an important global health care issue. SGA describes a neonate whose birth length and/or weight is more than 2 standard deviations below the mean or below the 10th percentile for gestational age compared to an appropriate reference population. In 2010, it was estimated that 32.4 million babies were born SGA in low and middle-income countries, constituting 27% of all live births. The prevalence of term SGA babies ranged from 5.3% of livebirths in east Asia to 41.5% in south Asia.
Multiple studies have shown increased morbidity and mortality amongst SGA. The suboptimal fetal growth occurring in IUGR fetuses is an important cause of perinatal mortality and morbidity. They are more likely to have neonatal infections, perinatal respiratory depression, jaundice, polycythaemia, hypoglycaemia, poor feeding, and hypothermia. These morbidities in turn place them at a higher risk of death. Reduction in the prevalence of SGA from 19.3% to 10.0% in low and middle income countries could reduce total neonatal deaths by 9.2%.
Typically up to 90% of infants born SGA experiences a period of accelerated linear growth during the first 12 months of life that results in a stature above -2 SD. Most of the catch-up growth occur during the first year and is near completion by 2 year of age. On average, children born SGA are shorter during childhood and as adults, reaching adult heights that are approximately 1 SD lower than the mean. They had a 7-fold higher risk of short stature in adulthood in comparison with the non-SGA group. SGA children who fail to catch up do not reach their target height range, and remain short throughout childhood and into adulthood. It is proposed that SGA children aged between 2 to 4 years old who show no evidence of catch-up growth with a height less than -2.5 SD should be eligible for growth hormone (GH) treatment. However, many a times this was missed/not adhered as there is no continuous follow-up for growth, as well as limited funding for treatment.
In the long-term, studies showed SGA babies are at significantly increased risk for type 2 diabetes mellitus, obesity, hypertension, dyslipidaemia, and insulin resistance. These diseases will ultimately leads to premature development of cardiovascular disease in later life.
SGA is an important global problem with consequences for child survival and development. As the evidence accumulates that poor fetal growth has both short-term consequences for survival and linear growth (i.e. stunting) and long-term adverse effects on cognitive and psychosocial development, adult stature and risk of adult metabolic diseases, there is a need to have more focus programmes and research to prevent it. Implementation of programmes and interventions to prevent fetal growth restriction and improve survival of small infants are key priorities to reduce childhood mortality and morbidity in low and middle income countries