Small for gestational age explained

Small for gestational age

Small for gestational age (SGA) newborns are those who are smaller in size than normal for the gestational age. SGA is most commonly defined as a weight below the 10th percentile for the gestational age.[1] SGA predicts susceptibility to hypoglycemia, hypothermia, and polycythemia.[2] By definition, at least 10% of all newborns will be labeled SGA. All SGA babies should be watched for signs of failure to thrive, hypoglycemia and other health conditions.

Causes

Being small for gestational age is broadly either:

Diagnosis

The condition is defined by birth weight and/or length.

Intrauterine growth restriction is generally diagnosed by measuring the mother's uterus, with the fundal height being less than it should be for that stage of the pregnancy. If it is suspected, the mother will usually be sent for an ultrasound to confirm.

Management

Ninety percent of babies born SGA catch up in growth by the time they reach two years old. For the ten percent of those without catchup growth by two years old, an endocrinologist should be consulted. Some cases warrant growth hormone therapy.

Hypoglycemia is common in asymmetrical SGA babies because their larger brains burn calories at a faster rate than their usually limited fat stores hold. Hypoglycemia is treated by frequent feedings and/or additions of cornstarch-based products (such as Duocal powder) to the feedings.

Some common conditions and disorders found in many that are SGA (and especially those without catchup growth by two years old).

For intrauterine growth restriction (during pregnancy), possible treatments include the early induction of labor, though this is only done if the condition has been diagnosed and seen as a risk to the health of the fetus.

Terminology

If small for gestational age babies have been the subject of intrauterine growth restriction, formerly known as intrauterine growth retardation,[4] the term "SGA associated with intrauterine growth restriction" is used.Intrauterine growth restriction refers to a condition in which a fetus is unable to achieve its genetically determined potential size. This functional definition seeks to identify a population of fetuses at risk for modifiable but otherwise poor outcomes. This definition intentionally excludes fetuses that are small for gestational age (SGA) but are not pathologically small.[5] Infants born SGA with severe short stature (or severe SGA) are defined as having a length less than 2.5 standard deviation scores below the mean.[6]

A related term is low birth weight, defined as an infant with a birth weight (that is, mass at the time of birth[7]) of less than 2500 g (5 lb 8 oz), regardless of gestational age at the time of birth.Other related terms include "very low birth weight", which is less than 1500 g, and "extremely low birth weight", which is less than 1000 g.[8] Normal weight at term delivery is 2500 g–4200 g.

SGA is not a synonym of low birth weight, very low birth weight, or extremely low birth weight.For example, with a 35-week gestational age delivery, 2250 g weight is appropriate for gestational age but is still low birth weight. One third of low-birth-weight neonates – infants weighing less than 2500 g – are small for gestational age.

There is an 8.1% incidence of low birth weight in developed countries, and 6–30% in developing countries. Much of this can be attributed to the health of the mother during pregnancy. One third of babies born with a low birth weight are also small for gestational age. Infants that are born at low birth weights are at risk of developing neonatal infection.

Both low and high maternal serum Vitamin D (25-OH) are associated with higher incidence SGA in white women, although the correlation does not seem to hold for African American women.[9]

Mean weight for gestational age at birth with standard deviation and 10th percentile calculated by Z-score[10] !Gestational age at birth (weeks)!Mean weight (grams)!SD!10th%
2246792354
23553109416
24626129473
25714156529
26819186597
27935215677
281073242770
291211269882
3013963091018
3115883361166
3218003711335
3320334051538
3422964281772
3525604402021
3627994412261
3730284562477
3832094322665
3933334192810
4034174162904
4134864222958
4235124292985
4335504442981
4435055032952

Notes and References

  1. https://www.nlm.nih.gov/medlineplus/ency/article/002302.htm Small for gestational age (SGA)
  2. Book: Cunningham . F. Gary . Williams Obstetrics . Leveno . Kenneth J. . Bloom . Steven L. . Spong . Catherine Y. . Dashe . Jodi S. . Hoffman . Barbara L. . Casey . Brian M. . Sheffield . Jeanne S. . 2013 . McGraw-Hill Education . 24 . New York, NY . Catherine Y. Spong.
  3. Book: Barker, D. J. P. . Fetal and infant origins of adult disease . British Medical Journal . London . 1992 . 0-7279-0743-3 .
  4. Web site: eMedicine - Intrauterine Growth Retardation. Dogra. Vikram S . 2007-11-28 .
  5. Web site: eMedicine - Fetal Growth Restriction. Ross. Michael G . 2010-02-25 .
  6. Clayton. PE. Cianfarani. S. Czernichow. P. Johannsson. G. Rapaport. R. Rogol. A. Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society.. The Journal of Clinical Endocrinology and Metabolism. March 2007. 92. 3. 804–10. 10.1210/jc.2006-2017. 17200164. free. 2108/45969. free.
  7. http://oasis.state.ga.us/oasis/help/mch.html Definitions
  8. Web site: eMedicine - Extremely Low Birth Weight Infant. Subramanian. KN Siva. 2007-11-28 .
  9. Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. Bodnar. LM. Catov. JM. Zmuda. JM. Cooper. ME. Parrott. MS. Roberts. JM. Marazita. ML. Simhan. HN. Journal of Nutrition. May 2010. 140. 5. 999–1006. 10.3945/jn.109.119636 . 20200114 . 2855265 .
  10. Talge. Nicole M.. Mudd. Lanay M.. Sikorskii. Alla. Basso. Olga. 5895957. 2014-05-01. United States Birth Weight Reference Corrected For Implausible Gestational Age Estimates. Pediatrics. en. 133. 5. 844–853. 10.1542/peds.2013-3285. 0031-4005. 24777216.