Abstract This International Consensus Guideline was developed by experts in the field of small for gestational age (SGA) of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Further, it presents long-term consequences of SGA birth and also reviews new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, as well as the metabolic and cardiovascular health of young adults born SGA after cessation of childhood GH treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardiometabolic health profile in adulthood. Children born SGA with persistent short stature < −2.5 SDS at age 2 years or < −2 SDS at 3 to 4 years of age, should be referred for diagnostic workup. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability, and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033 to 0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3 to 4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle. Keywords: SGA, etiology, consequences, management, genetics, GH
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Anita C S Hokken-Koelega, Manouk van der Steen, Margaret C S Boguszewski et al.. International Consensus Guideline on Small for Gestational Age: Etiology and Management From Infancy to Early Adulthood. Endocrine Reviews. (2023). https://doi.org/10.1210/endrev/bnad002 Anita C S Hokken-Koelega, Manouk van der Steen, Margaret C S Boguszewski, Stefano Cianfarani, Jovanna Dahlgren, Reiko Horikawa, Veronica Mericq, Robert Rapaport, Abdullah Alherbish, Debora Braslavsky, Evangelia Charmandari, Steven D Chernausek, Wayne S Cutfield, Andrew Dauber, Asma Deeb, Wesley J Goedegebuure, Paul L Hofman, Elvira Isganatis, Alexander A Jorge, Christina Kanaka-Gantenbein, Kenichi Kashimada, Vaman Khadilkar, Xiao-Ping Luo, Sarah Mathai, Yuya Nakano, Mabel Yau
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Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands 2
Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands 3
Department of Pediatrics, Federal University of Parana, 1154 Curitiba, Brazil 4
Department of Systems Medicine, University of Rome ‘Tor Vergata’, 00133 Rome, Italy 5
Diabetology and Growth Disorders Unit, IRCCS “Bambino Gesù” Children's Hospital, 00146 Rome, Italy 6
Department of Women's and Children's Health, Karolinska Institute, 17177 Stockholm, Sweden 7
Department of Pediatrics, The Sahlgrenska Academy, the University of Gothenburg and Queen Silvia Children's Hospital, 41650 Gothenburg, Sweden 8
Division of Endocrinology and Metabolism, National Center for Child Health and Development, 578535 Tokyo, Japan 9
Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, 8320000 Santiago de Chili, Chili 10
Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY 10029, USA 11
Medical Division, Al Habib Medical Group, Riyadh 12214, Saudi Arabia 12
Centro de Investigaciones Endocrinológicas “Dr. Cesar Bergadá” (CEDIE), División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, C1425 Buenos Aires, Argentina 13
Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece 14
Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece 15
Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, OK 73104 Oklahoma City, USA 16
Division of Pediatric Endocrinology, Liggins Institute, University of Auckland, Auckland 1142, New Zealand 17
Division of Endocrinology, Children's National Hospital, Washington, DC 20012, USA 18
Paediatric Endocrine Division, Sheikh Shakhbout Medical City and College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates 19
Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands 20
Division of Pediatric Endocrinology, Liggins Institute, University of Auckland, Auckland 1142, New Zealand 21
Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA 22
Unidade de Endocrinologia Genética (LIM25) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil 23
Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece 24
Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan 25
Department of Pediatrics, Jehangir Hospital, Pune, India 26
Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 27
Department of Pediatrics, Christian Medical College, Vellore, India 28
Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan 29
Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY 10029, USA 