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Small for gestational age

Small for gestational age (SGA) newborns are those who are smaller in size than normal for the gestational age, most commonly defined as a weight below the 10th percentile for the gestational age.

Small for gestational age
Graph showing which babies fit the definition of small. (DiseaseDB #31952)
SpecialtyPediatrics

Contents

Being small for gestational age is broadly either:

The condition is determined by birth weight and/or length.[citation needed]

A related condition, 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.[citation needed]

Ninety percent of babies born SGA catch up in growth by the age of 2. However, all SGA babies should be watched for signs of failure to thrive, hypoglycemia and other conditions common to SGA babies (see below). 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. For the 10 percent of those that are SGA without catchup growth by the age of 2, an endocrinologist should be consulted. Some cases warrant growth hormone therapy.There are some common conditions and disorders found in many that are SGA (and especially those that are SGA without catchup growth by age 2). They should be treated by the appropriate specialist:[citation needed]

  • Gastroenterologist - for gastrointestinal issues such as: reflux and/or delayed gastric emptying
  • Dietitian - to address caloric deficits. Dietitians are usually brought in for cases that include failure to thrive. Also, according to the theory of thrifty phenotype, causes of growth restriction also trigger epigenetic responses in the fetus that are otherwise activated in times of chronic food shortage. If the offspring actually develops in an environment rich in food it may be more prone to metabolic disorders, such as obesity and type II diabetes.
  • Speech-language pathologist or occupational therapist - for feeding issues. Occupational therapists may also treat sensory issues
  • Behaviorist - for feeding issues, a behavioral approach may also be used, but usually for older children (over 2)
  • Allergist - to diagnose or rule out food allergies (not necessarily more common in those SGA than the normal population)
  • Ear, nose and throat doctor - to diagnose enlarged adenoids or tonsils (not necessarily more common in those SGA than the normal population)

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.[citation needed]

By definition, at least 10% of all newborns will be labeled SGA. Not all newborns that are SGA are pathologically growth restricted and, in fact, may be constitutionally small. However, the designation has prognostic importance because it predicts susceptibility to hypoglycemia, hypothermia, and polycythemia.

If small for gestational age babies have been the subject of intrauterine growth restriction, formerly known as intrauterine growth retardation, 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. 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.

A related term is low birth weight, defined as an infant with a birth weight (that is, mass at the time of birth) 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. 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. Example: 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.[citation needed]

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.

Mean Weight for Gestational age at birth with Standard Deviation and 10th percentile calculated by Z-score
Gestational Age at birth (weeks) Mean weight (grams) SD 10th%
22 467 92 354
23 553 109 416
24 626 129 473
25 714 156 529
26 819 186 597
27 935 215 677
28 1073 242 770
29 1211 269 882
30 1396 309 1018
31 1588 336 1166
32 1800 371 1335
33 2033 405 1538
34 2296 428 1772
35 2560 440 2021
36 2799 441 2261
37 3028 456 2477
38 3209 432 2665
39 3333 419 2810
40 3417 416 2904
41 3486 422 2958
42 3512 429 2985
43 3550 444 2981
44 3505 503 2952
  1. Small for gestational age (SGA) at MedlinePlus. Update Date: 8/4/2009. Updated by: Linda J. Vorvick. Also reviewed by David Zieve.
  2. Ross, Michael G. "eMedicine - Fetal Growth Restriction". Retrieved2010-02-25.
  3. Barker, D. J. P., ed. (1992). Fetal and infant origins of adult disease. London: British Medical Journal. ISBN 0-7279-0743-3.
  4. Cunningham, F. Gary; Leveno, Kenneth J.; Bloom, Steven L.; Spong, Catherine Y.; Dashe, Jodi S.; Hoffman, Barbara L.; Casey, Brian M.; Sheffield, Jeanne S. (2013). Williams Obstetrics (24 ed.). New York, NY: McGraw-Hill Education.
  5. Dogra, Vikram S. "eMedicine - Intrauterine Growth Retardation". Retrieved2007-11-28.
  6. Clayton, PE; Cianfarani, S; Czernichow, P; Johannsson, G; Rapaport, R; Rogol, A (March 2007). "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. 92 (3): 804–10. doi:10.1210/jc.2006-2017. PMID 17200164.
  7. Definitions Archived 2012-04-02 at the Wayback Machine from Georgia Department of Public Health. Date: 12/04/2008. Original citation: "Birthweight: Infant's weight recorded at the time of birth"
  8. Subramanian, KN Siva. "eMedicine - Extremely Low Birth Weight Infant". Retrieved2007-11-28.
  9. Bodnar, LM; Catov, JM; Zmuda, JM; Cooper, ME; Parrott, MS; Roberts, JM; Marazita, ML; Simhan, HN (May 2010). "Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women". Journal of Nutrition. 140 (5): 999–1006.
  10. Talge, Nicole M.; Mudd, Lanay M.; Sikorskii, Alla; Basso, Olga (2014-05-01). "United States Birth Weight Reference Corrected For Implausible Gestational Age Estimates". Pediatrics. 133 (5): 844–853. doi:10.1542/peds.2013-3285. ISSN 0031-4005. PMID 24777216. S2CID 5895957.
Classification

Small for gestational age
Small for gestational age Language Watch Edit Small for gestational age SGA newborns are those who are smaller in size than normal for the gestational age most commonly defined as a weight below the 10th percentile for the gestational age 1 Small for gestational ageGraph showing which babies fit the definition of small DiseaseDB 31952 SpecialtyPediatrics Contents 1 Causes 2 Diagnosis 3 Management 4 Terminology 5 References 6 External linksCauses EditBeing small for gestational age is broadly either 2 Being constitutionally small wherein the state is basically a genetic trait of the baby Intrauterine growth restriction also called pathological SGA Diagnosis EditThe condition is determined by birth weight and or length citation needed A related condition 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 citation needed Management EditNinety percent of babies born SGA catch up in growth by the age of 2 However all SGA babies should be watched for signs of failure to thrive hypoglycemia and other conditions common to SGA babies see below 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 For the 10 percent of those that are SGA without catchup growth by the age of 2 an endocrinologist should be consulted Some cases warrant growth hormone therapy There are some common conditions and disorders found in many that are SGA and especially those that are SGA without catchup growth by age 2 They should be treated by the appropriate specialist citation needed Gastroenterologist for gastrointestinal issues such as reflux and or delayed gastric emptying Dietitian to address caloric deficits Dietitians are usually brought in for cases that include failure to thrive Also according to the theory of thrifty phenotype causes of growth restriction also trigger epigenetic responses in the fetus that are otherwise activated in times of chronic food shortage If the offspring actually develops in an environment rich in food it may be more prone to metabolic disorders such as obesity and type II diabetes 3 Speech language pathologist or occupational therapist for feeding issues Occupational therapists may also treat sensory issues Behaviorist for feeding issues a behavioral approach may also be used but usually for older children over 2 Allergist to diagnose or rule out food allergies not necessarily more common in those SGA than the normal population Ear nose and throat doctor to diagnose enlarged adenoids or tonsils not necessarily more common in those SGA than the normal population 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 citation needed Terminology EditBy definition at least 10 of all newborns will be labeled SGA Not all newborns that are SGA are pathologically growth restricted and in fact may be constitutionally small However the designation has prognostic importance because it predicts susceptibility to hypoglycemia hypothermia and polycythemia 4 If small for gestational age babies have been the subject of intrauterine growth restriction formerly known as intrauterine growth retardation 5 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 2 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 Example 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 citation needed 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 22 467 92 35423 553 109 41624 626 129 47325 714 156 52926 819 186 59727 935 215 67728 1073 242 77029 1211 269 88230 1396 309 101831 1588 336 116632 1800 371 133533 2033 405 153834 2296 428 177235 2560 440 202136 2799 441 226137 3028 456 247738 3209 432 266539 3333 419 281040 3417 416 290441 3486 422 295842 3512 429 298543 3550 444 298144 3505 503 2952References Edit Small for gestational age SGA at MedlinePlus Update Date 8 4 2009 Updated by Linda J Vorvick Also reviewed by David Zieve a b Ross Michael G eMedicine Fetal Growth Restriction Retrieved 2010 02 25 Barker D J P ed 1992 Fetal and infant origins of adult disease London British Medical Journal ISBN 0 7279 0743 3 Cunningham F Gary Leveno Kenneth J Bloom Steven L Spong Catherine Y Dashe Jodi S Hoffman Barbara L Casey Brian M Sheffield Jeanne S 2013 Williams Obstetrics 24 ed New York NY McGraw Hill Education Dogra Vikram S eMedicine Intrauterine Growth Retardation Retrieved 2007 11 28 Clayton PE Cianfarani S Czernichow P Johannsson G Rapaport R Rogol A March 2007 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 92 3 804 10 doi 10 1210 jc 2006 2017 PMID 17200164 Definitions Archived 2012 04 02 at the Wayback Machine from Georgia Department of Public Health Date 12 04 2008 Original citation Birthweight Infant s weight recorded at the time of birth Subramanian KN Siva eMedicine Extremely Low Birth Weight Infant Retrieved 2007 11 28 Bodnar LM Catov JM Zmuda JM Cooper ME Parrott MS Roberts JM Marazita ML Simhan HN May 2010 Maternal serum 25 hydroxyvitamin D concentrations are associated with small for gestational age births in white women Journal of Nutrition 140 5 999 1006 Talge Nicole M Mudd Lanay M Sikorskii Alla Basso Olga 2014 05 01 United States Birth Weight Reference Corrected For Implausible Gestational Age Estimates Pediatrics 133 5 844 853 doi 10 1542 peds 2013 3285 ISSN 0031 4005 PMID 24777216 S2CID 5895957 External links EditClassificationDICD 10 P05 P07ICD 9 CM 764 765MeSH D007230 Retrieved from https en wikipedia org w index php title Small for gestational age amp oldid 1039266418, wikipedia, wiki, book,

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