Abstract

The aim of this paper is to give an overview to Estonian physicians about growth hormone (GH) treatment in children born small for gestational age (SGA). Small for gestational age means that newborn is 2 standard deviations smaller than normal for the baby’s sex and gestational age. Usually 2-5% of children are born SGA (2). Most children born SGA catch up in growth within two years of life, but 10-15% of SGA children remain short throughout childhood and many of them remain short as adults (15).

Growth hormone (GH) treatment has been approved for SGA children who do not exhibit catch-up growth (22) in Europe and USA. European Medicines Agency (EMA) allows GH treatment to > 4-year-old SGA children who are 2.5 SD below their age group in height, show no catch-up growth (growth velocity is < 0 SD), and are more than 1 SD sorter than their target height calculated from their parents’ heights (22). Growth hormone dosages of up to 35 μg/kg per day is approved by EMA to treat short SGA children.

There are a limited number of studies where SGA children on GH treatment have been followed until final height. The mean effect of GH treatment on final height is +1.33 SD scores, which in Estonia means +8.7 cm in men and +7.9 cm in women (26).
Long-term GH therapy for SGA children is relatively safe and well tolerated (46, 47). Increase in insulin resistance has been reported during GH therapy in SGA children, but this effect ended after the end of therapy (10, 40). Growth hormone treatment has several metabolic benefits, as it normalises blood pressure, increases lean mass and bone mineral density, and reduces body fat mass (20, 24).