Management of Short Children Born Small for Gestational Age

Lee, Chernausek, Hokken-Koelega, and Czernichow,1 for the International SGA Advisory Board, have presented a complete guide for management of short children born small for gestational age (SGA). This project received research support from Pharmacia Corporation (Peapack, NJ). This suggested clinical pathway addresses those infants born SGA as defined by birth weight and/or length at least 2 standard deviations (SD) below the mean for gestational age (less than or equal to −2 SD), who remain short at 2 to 3 years of age. The authors point out that –2 SD is equivalent to the 2.3 percentile, allowing one to calculate that in the United States ∼91 000 infants were born SGA in 1999, the most recent year for which adult birth data are available from the National Center for Health Statistics.2 Furthermore, it is estimated that 10% of children born SGA will remain less than or equal to −2 SD for height throughout childhood and adolescence and into adulthood,3,4 thus making over 9000 children annually in the United States alone eligible to receive growth hormone (GH) according to the suggested protocol. A brief discussion of the definition of terms and accuracy issues is necessary. Lee et al1 note that the most commonly used data on intrauterine growth in the United States is derived from charts developed by Usher and McLean.5 These data provide information about the 10th, 50th, and 90th percentiles, rather than by SDs above or below the mean. Many centers continue to use … Address correspondence to Jeffrey J. Pomerance, MD, 2214 Loma Vista St, Pasadena, CA 91104-4906. E-mail: jpomerance{at}msn.com