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Submitted on September 13, 2006
Accepted on December 26, 2006
University of Manchester, UK; "Tor Vergata" University, Rome, Italy; Robert Debre Hospital, Paris, France; Sahlgrenska University Hospital, Gothenburg, Sweden; Mount Sinai School of Medicine, New York, USA; University of Virginia, Charlottesville, USA
* To whom correspondence should be addressed. E-mail: arogol{at}cstone.net.
Objective: Low birth weight (LBW) remains a major cause of morbidity and mortality in early infancy and childhood. It is associated with an increased risk of health problems later in life, in particular coronary heart disease and stroke. A meeting was convened to identify the key health issues facing a child born small-for-gestational age (SGA) and to propose management strategies.
Participants: There were 42 participants chosen for their expertise in obstetrics, peri- and neonatal medicine, paediatrics, paediatric and adult endocrinology, epidemiology and pharma.
Evidence: Written materials were exchanged, reviewed, revised and then made available to all. This formed the basis for discussions at the meeting. Where published data were not available or adequate, discussion was based on expert clinical opinions.
Consensus Process: Each set of questions was considered by all, and then discussed in plenary with consensus and unresolved issues identified. The consensus statement was prepared in plenary session and then edited by the group chairs and shared with all participants.
Conclusions: The diagnosis of SGA should be based on accurate anthropometry at birth including weight, length and head circumference. We recommend early surveillance in a growth clinic for those without catch-up. Early neurodevelopment evaluation and interventions are warranted in at-risk children. Endocrine and metabolic disturbances in the SGA child are recognised, but infrequent. For the 10% who lack catch-up, GH treatment can increase linear growth. Early intervention with GH for those with severe growth retardation (height SDS <-2.5, age 2-4 y) should be considered at a dose of 35-70µg/kg/day. Long-term surveillance of those treated is essential. The associations at a population level between LBW, including SGA, and coronary heart disease and stroke in later life are recognised, but there is inadequate evidence to recommend routine health surveillance of all adults born SGA, outside of normal clinical practice.
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