Small for gestational age children

Small-for-gestational-age (SGA) children have been the subject of scientific interest over the last century. Since 2013, the 10th percentile for height and/or weight for the corresponding gestational age has been used as a cut-off to define the condition. This specific population group is characterized by multiple early and late complications.The aim of the present paper is to review the data in the literature regarding the prevalence, early and late complications associated with SGA delivery.The most commonly used cut-offs for defining an SGA child are the 2,3rd, 3rd, and 10th percentiles. Using a different definition and curves results in a large difference in prevalence. The presented cohort is characterized by a variety of early and late complications. Early complications include mortality, hypoglycemia, and hypothermia. Mortality in this cohort can be several times higher compared to children born adequate for their gestational age (AGA). Hypoglycemia, especially prolonged and unrecognized, can lead to permanent brain damage. Hypothermia was more common in the group of children born SGA compared to those born AGA.Late complications can develop at any stage of a person’s life. This group includes metabolic disorders, hypertension, precocious puberty, and reduced bone density. To date, an increased cardiovascular risk has been repeatedly demonstrated in adults born SGA. Studies have shown that those born SGA are likely to develop metabolic complications as early as infancy. The most common metabolic disorders are insulin resistance, impaired glucose tolerance and type 2 diabetes mellitus

Potential improvement of pregnancy outcome through prenatal small for gestational age detection

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. OBJECTIVE: To assess differences in mode of delivery and pregnancy outcome between prenatally detected and nonprenatally detected small for gestational age (SGA) neonates born at term.STUDY DESIGN: We performed a retrospective multicenter cohort study. All singleton infants, born SGA in cephalic position between 36(0/7) and 41(0/7) weeks gestation, were classified as either prenatally detected SGA or nonprenatally detected SGA. With propensity score matching we created groups with comparable baseline characteristics. We compared these groups for composite adverse perinatal outcome, labor induction, and cesarean section rates.RESULTS: We included 718 SGA infants, of whom 555 (77%) were not prenatally detected. Composite adverse neonatal outcome did not differ statistically significant between the matched prenatally detected and the nonprenatally detected group (5.5 vs. 7.4%, odds ratio [OR] 0.74, 95% confidence interval [CI]: 0.30-1.8). However, perinatal mortality only occurred in the nonprenatally detected group (1.8% [3/163] in the matched cohort, 1.3% [7/555] in the complete cohort). In the propensity matched prenatally detected SGA group both induction of labor (57 vs. 9%, OR 14.0, 95% CI: 7.4-26.2) and cesarean sections (20 vs. 8%, OR 2.9, 95% CI: 1.5-5.8) were more often performed compared with the nonprenatally detected SGA group.CONCLUSION: Prenatal SGA detection at term allows timely induction of labor and cesarean sections thus potentially preventing stillbirth

Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets

Objectives: To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard.Design: Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated.Setting: CHERG birth cohorts from 14 population based sites in low and middle income countries.Main outcome measures: In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%.Results: In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (\u3c2500 \u3eg) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was the highest (34%); about 26% of neonatal deaths were attributable to infants born small for gestational age. Reduction of the prevalence of small for gestational age from 19.3% to 10.0% in these countries could reduce neonatal deaths by 9.2% (254 600 neonatal deaths; 164 800 to 449 700).Conclusions: In low and middle income countries, about one in five infants are born small for gestational age, and one in four neonatal deaths are among such infants. Increased efforts are required to improve the quality of care for and survival of these high risk infants in low and middle income countries

Estimates of Burden and Consequences of Infants Born Small for Gestational Age in Low and Middle Income Countries with INTERGROWTH-21(st) Standard: Analysis of CHERG Datasets.

Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard. Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated. Setting CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%. Results In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (\u3c2500 g) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was the highest (34%); about 26% of neonatal deaths were attributable to infants born small for gestational age. Reduction of the prevalence of small for gestational age from 19.3% to 10.0% in these countries could reduce neonatal deaths by 9.2% (254 600 neonatal deaths; 164 800 to 449 700). Conclusions In low and middle income countries, about one in five infants are born small for gestational age, and one in four neonatal deaths are among such infants. Increased efforts are required to improve the quality of care for and survival of these high risk infants in low and middle income countrie

Promotion of faster weight gain in infants born small for gestational age - Is there an adverse effect on later blood pressure?

Background - Being born small for gestational age is associated with later risk factors for cardiovascular disease, such as high blood pressure. Promotion of postnatal growth has been proposed to ameliorate these effects. There is evidence in animals and infants born prematurely, however, that promotion of growth by increased postnatal nutrition increases rather than decreases later cardiovascular risk. We report the long-term impact of growth promotion in term infants born small for gestational age ( birth weight < 10th percentile).Methods and Results - Blood pressure was measured at 6 to 8 years in 153 of 299 ( 51%) of a cohort of children born small for gestational age and randomly assigned at birth to receive either a standard or a nutrient-enriched formula. The enriched formula contained 28% more protein than standard formula and promoted weight gain. Diastolic and mean ( but not systolic) blood pressure was significantly lower in children assigned to standard compared with nutrient-enriched formula ( unadjusted mean difference for diastolic blood pressure, - 3.2 mm Hg; 95% CI, - 5.8 to - 0.5; P = 0.02) independent of potential confounding factors ( adjusted difference, - 3.5 mm Hg; P = 0.01). In observational analyses, faster weight gain in infancy was associated with higher later blood pressure.Conclusions - In the present randomized study targeted to investigate the effect of early nutrition on long-term cardiovascular health, we found that a nutrient-enriched diet increased later blood pressure. These findings support an adverse effect of relative "overnutrition" in infancy on long-term cardiovascular disease risk, have implications for the early origins of cardiovascular disease hypothesis, and do not support the promotion of faster weight gain in infants born small for gestational age

Transgenerational transmission of small for gestational age

Objective: To evaluate the transgenerational transmission of small for gestational age. Methods: Cohort study including a random sample of 2,043 offspring of deliveries occurring from 1975 to 1993. Of 623 offspring -now adults- that agreed to participate, 152 adults (72 born small-for-gestational age (SGA) and 80 with appropriate intrauterine growth) reported to have at least one child. Multiple regression analysis was used to determine the presence of SGA (defined as a birthweight < 10th percentile) or placental mediated disease (defined as the presence of SGA, preeclampsia or gestational hypertension) in the following generation. Results: Descendants from SGA adults presented lower birthweight percentile (median 26 [interquartile range 7-52] vs. 43 [19-75]; p<0.001) and higher prevalence of SGA (40.3% vs. 16.3%; p=0.001) and placental mediated disease (43.1% vs. 17.5%; p=0.001). After adjustment for confounder variables, parental SGA background was associated with an almost three-fold increased risk of subsequent SGA or any placental mediated disease in the following generation. This association was stronger in SGA mothers as compared to fathers. Conclusions: Our data provides evidence suggesting a transgenerational transmission of SGA highlighting the importance of public health strategies for preventing intrauterine growth impairment

Morbidity and Mortality in small for gestational age very low birth weight infants in a middle-income country

Objective: To evaluate the impact of small for gestational age on outcomes of very low birth weight infants at Groote Schuur Hospital, Cape Town, South Africa. Study design: Data was obtained from Vermont Oxford Network Groote Schuur Hospital database from 2012 to 2018. Fenton growth charts were used to define small for gestational age as birth weight < 10th centile for gestational age. Results: Mortality (28.9% vs 18.5%, adjusted risk ratio (aRR) 2.1, 95% confidence interval (CI) 1.6-2.7), bronchopulmonary dysplasia (14% vs 4.5%, aRR 3.7, 95% CI 2.3-6.1) and late onset sepsis (16.7% vs 9.6%, aRR 2.3, 95% CI 1.6-3.3) were higher in the small for gestational age than in the non-small for gestational age group. Conclusion: Small for gestational age infants have a higher risk of mortality and morbidity among very low birth weight infants at Groote Schuur Hospital. This may be useful for counseling and perinatal management