Small for Gestational Age (SGA)

Small for Gestational Age (SGA)

The term Small for Gestational Age describes newborns who are too small for the corresponding age of maturity. The English term has prevailed and is abbreviated as SGA. Most SGA children will catch up later and reach normal height and weight.

What does Small for Gestational Age stand for?

The term Small for Gestational Age, also abbreviated to SGA, has come to describe newborns who are too small and light at birth. In these children, the birth height or birth weight is in the lower range of the statistical normal distribution. There are two different definitions. For what does microphthalmos mean, please visit etaizhou.info.

One definition places length and weight at least two standard deviations below the mean. This corresponds to a weight and length below the 3rd percentile. All doctors who deal with the long-term development of children favor this definition. In most cases, growth does not slow down until the last trimester of pregnancy.

The fetus no longer gains weight, but the child’s size at birth is still normal. In these cases we speak of asymmetric retardation. If both weight and height are too low, there is a symmetrical retardation. This definition satisfies the statistics and is therefore not suitable for finding the cause of the delayed development.

There is also the term intrauterine growth retardation, which is also used synonymously with SGA. Strictly speaking, however, this definition only includes children who show delayed growth due to a disease. However, only a subset of all SGA children fall under this definition. The incidence of delayed growth during pregnancy is approximately five percent.

Causes

There are many reasons for delayed growth. In most cases, it is just a deviation in normal development. Growth is usually caught up after birth. It is often not possible to speak of a pathological development. This is just a statistical difference. Nevertheless, there are of course reasons for such statistical fluctuations.

These cannot be determined in individual cases. However, it is often due to the diet and lifestyle of the mother. Developmental delays in the fetus are statistically more frequent, particularly in mothers who smoke. Nutritional status and the supply of nutrients to the fetus via the placenta also play a role. In some cases, infections and other diseases during pregnancy also have an impact on growth.

As a rule, the growth and development of the child return to normal after birth. However, a significantly smaller percentage of children have developmental delays due to a serious medical condition. These are often genetic defects that inhibit growth and sometimes cause general physical dysplasia.

Serious illnesses in the pregnant mother, such as rubella, can also lead to growth retardation in the fetus. Alcohol abuse during pregnancy also plays a major role. Last but not least, the intake of medication must be checked.

Symptoms, Ailments & Signs

The English term “Small for Gestational Age” already indicates the actual characteristic of SGA. At birth, the affected children are too small in relation to the age of maturity. In addition, they have a birth weight that is too low compared to the statistical normal distribution. However, most children catch up with height and weight and later develop normally.

For a few, however, there is a risk that the growth process will be delayed. As a result, those affected in these cases also suffer from short stature in adulthood. This is particularly the case if no significant growth spurt has set in by the age of two. After that, the growth deficit can usually no longer be made up.

The slowdown in growth often begins as early as the third trimester of pregnancy. About 30 percent of those affected then give birth prematurely. Children with SGA often suffer from constant hypoglycaemia and reduced blood calcium levels immediately after birth. When there is a lack of oxygen, more red blood cells are formed.

This increases the viscosity of the blood and leads to circulatory disorders. Severe brain damage leading to paralysis or movement disorders is observed only slightly more frequently than in children of normal weight. Slight disturbances in fine motor skills and movement coordination occur somewhat more frequently in affected school children. The risk of developing diabetes and cardiovascular diseases in adulthood is also increased.

Diagnosis & course of disease

According to the SGA, an infant is too small after birth if it is less than 46 centimeters in length and/or weighs less than 2600 grams. This corresponds to twice the standard deviation below the mean values ​​of 51 centimeters birth length and 3400 grams birth weight. As a rule, this is not a problem because the infant catches up with its normal development in over 90 percent of the cases.

The remaining 10 percent may experience short stature. In the case of pathological disorders, the specific cause must be sought. Children with developmental delays are statistically at greater risk of developing certain diseases in later years. They are particularly at risk of developing type 2 diabetes mellitus, obesity and metabolic syndrome.

Already after the birth of SGA children there is increased insulin resistance, the risk of hypoglycaemia and metabolic disorders. If growth does not start to increase by the end of the second year of life, it will remain a short stature.

An SGA is diagnosed by measuring the body length and body weight after birth and at the same time determining the age of maturity. Weight, length and head circumference are regularly documented within two years. In individual cases, an underlying pathological cause must be sought.

Complications

As a rule, the small for gestational age condition can have a very negative impact on the quality of life of the person affected. The exact symptoms and complications of this disease depend heavily on the exact birth weight and birth size, so that a general prediction about the course can usually not be made. Those affected suffer from this disease, however, from short stature and also from diabetes or obesity.

These symptoms of the Small for Gestational Age disease can lead to bullying or teasing, especially in young people, and thus also cause depression and other psychological problems. Furthermore, the metabolism of those affected is often disturbed, resulting in insulin resistance.

Treatment for Small for Gestational Age depends on the exact causes and can be managed with the help of medication. Complications usually do not arise. However, normal growth cannot be achieved even with the help of medication. It is also not generally possible to predict whether the disease will lead to a reduced life expectancy.

Treatment & Therapy

SGA is treated with adequate nutrition and an adequate supply of vitamins, minerals and trace elements. At the same time, the development of weight and height is closely monitored. If the child remains well below the mean value until the end of the second year of life, other causes of the growth retardation must be ruled out in the differential diagnosis.

If short stature persists, hormone therapy with growth hormone can be tried from the age of four. In many cases, the children then reach a normal growth length within three years. However, growth hormone therapy should be continued without interruption until the final length is reached in order not to risk a growth deficit. In rare cases, however, no appreciable growth is achieved even with hormone treatment.

Prevention

The most important measure to prevent SGA in the offspring is to maintain a healthy lifestyle, especially during pregnancy. This includes consistently abstaining from smoking and alcohol. Furthermore, a balanced diet and plenty of exercise also have a positive effect on the development of the child.

Aftercare

The English term “Small for Gestational Age” already indicates the actual characteristic of SGA. At birth, the affected children are too small in relation to the age of maturity. In addition, they have a birth weight that is too low compared to the statistical normal distribution. However, most children catch up with height and weight and later develop normally. For a few, however, there is a risk that the growth process will be delayed.

As a result, those affected in these cases also suffer from short stature in adulthood. This is particularly the case if no significant growth spurt has set in by the age of two. After that, the growth deficit can usually no longer be made up. The slowdown in growth often begins as early as the third trimester of pregnancy.

Around 30 percent of those affected then give birth prematurely. Children with SGA often suffer from constant hypoglycaemia and reduced blood calcium levels immediately after birth. When there is a lack of oxygen, more red blood cells are formed. This increases the viscosity of the blood and leads to circulatory disorders.

Severe brain damage that leads to paralysis or movement disorders is observed only slightly more frequently than in children of normal weight. Slight disturbances in fine motor skills and movement coordination occur somewhat more frequently in affected school children. The risk of developing diabetes and cardiovascular diseases in adulthood is also increased.

You can do that yourself

In many children, the initial short stature is followed by a compensatory growth development. However, there is also a risk that the patients will continue to be very small.

In everyday life, parents should pay attention to a healthy diet in order to avoid deficiency symptoms and to reduce the risk of diabetes. In addition, regular check-ups with the doctor are required, who will assess the further development of height and weight. Also in later years, a close medical check-up makes sense to minimize the risk of possible secondary diseases. At primary school age, certain neurological abnormalities can occur, which are reflected in movement disorders or limited fine motor skills. Such symptoms require close examination in order to counteract worse disorders in time.

There is sometimes increased psychological stress in the family of those affected. Above all, the patients themselves feel inferior because of their short stature. In such cases, a self-help group helps to cope better with the situation. In addition, this strengthens self-confidence and the short patients do not feel alone with their problem. Daily support often comes from family and friends. There is also special furniture and other aids that make life easier for people of short stature.

Small for Gestational Age (SGA)