Milmedika

Children born small for gestational age (SGA) require special attention when monitoring their growth and development. The diagnosis is based on birth weight and length, gestational age, and population-specific reference values for sex and gestational period.

Growth and development

Most children born SGA catch up in growth within the first two years of life. However, about 10% remain permanently short-statured and continue to be shorter in adulthood.

Short stature in these children has been recognized as an indication for growth hormone (GH) therapy. The European Medicines Agency approved this treatment in 2003.

In Montenegro, children born SGA who do not catch up in growth by the age of four are considered candidates for growth hormone therapy.

A case of successful therapy

The first patient in Montenegro to receive growth hormone therapy for this indication started treatment in early 2006. At birth, she weighed 656 grams and was 33 cm long (born at 25 weeks of gestation). By the age of four, she was 18 cm behind her target height. Today, at 17 years old, she is a high school junior and 167 cm tall.

Effects of growth hormone therapy

Growth hormone therapy accelerates linear growth and helps normalize height. Studies confirm its effectiveness, with 98% of treated children reaching their genetic height potential. Beyond height improvement, the therapy also provides metabolic, cardiovascular, and psychosocial benefits.

Research indicates that in girls born SGA, puberty and menarche may occur 5–10 months earlier, which can further impact final height.

Long-term health risks

Children born SGA are at an increased risk of developing metabolic disorders due to fetal malnutrition and the reprogramming of metabolic processes. The most common risks include:

• Obesity
• Insulin resistance
• Metabolic syndrome
• Diabetes
• Cardiovascular disease

Given these risks, regular monitoring is essential, including weight and height tracking, puberty development, blood pressure, blood sugar and insulin levels, and lipid profile. Additionally, an ultrasound assessment of the intima-media thickness in the posterior wall of the common carotid artery is recommended for children, adolescents, and adults born SGA.

Prof. Dr. Mira Samardžić