title: Latin American consensus: children born small for gestational age.
abstract: BACKGROUND
  Children born small for gestational age (SGA) experience higher rates of morbidity and mortality than those born appropriate for gestational age. In Latin America, identification and optimal management of children born SGA is a critical issue. Leading experts in pediatric endocrinology throughout Latin America established working groups in order to discuss key challenges regarding the evaluation and management of children born SGA and ultimately develop a consensus statement.
  
  
  CONCLUSIONS
  SGA is defined as a birth weight and/or birth length greater than 2 standard deviations (SD) below the population reference mean for gestational age. SGA refers to body size and implies length-weight reference data in a geographical population whose ethnicity is known and specific to this group. Ideally, each country/region within Latin America should establish its own standards and make relevant updates. SGA children should be evaluated with standardized measures by trained personnel every 3 months during year 1 and every 6 months during year 2. Those without catch-up growth within the first 6 months of life need further evaluation, as do children whose weight is ≤ -2 SD at age 2 years. Growth hormone treatment can begin in SGA children > 2 years with short stature (< -2.0 SD) and a growth velocity < 25th percentile for their age, and should continue until final height (a growth velocity below 2 cm/year or a bone age of > 14 years for girls and > 16 years for boys) is reached. Blood glucose, thyroid function, HbA1c, and insulin-like growth factor-1 (IGF-1) should be monitored once a year. Monitoring insulin changes from baseline and surrogates of insulin sensitivity is essential. Reduced fetal growth followed by excessive postnatal catch-up in height, and particularly in weight, should be closely monitored. In both sexes, gonadal function should be monitored especially during puberty.
  
  
  CONCLUSIONS
  Children born SGA should be carefully followed by a multidisciplinary group that includes perinatologists, pediatricians, nutritionists, and pediatric endocrinologists since 10% to 15% will continue to have weight and height deficiency through development and may benefit from growth hormone treatment. Standards/guidelines should be developed on a country/region basis throughout Latin America.
authors.affiliation: Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil. margabogus@uol.com.br
authors.forename: Margaret C S
authors.initials: MC
authors.lastname: Boguszewski
authors.forename: Veronica
authors.initials: V
authors.lastname: Mericq
authors.forename: Ignacio
authors.initials: I
authors.lastname: Bergada
authors.forename: Durval
authors.initials: D
authors.lastname: Damiani
authors.forename: Alicia
authors.initials: A
authors.lastname: Belgorosky
authors.forename: Peter
authors.initials: P
authors.lastname: Gunczler
authors.forename: Teresa
authors.initials: T
authors.lastname: Ortiz
authors.forename: Mauricio
authors.initials: M
authors.lastname: Llano
authors.forename: Horacio M
authors.initials: HM
authors.lastname: Domené
authors.forename: Raúl
authors.initials: R
authors.lastname: Calzada-León
authors.forename: Armando
authors.initials: A
authors.lastname: Blanco
authors.forename: Margarita
authors.initials: M
authors.lastname: Barrientos
authors.forename: Patricio
authors.initials: P
authors.lastname: Procel
authors.forename: Roberto
authors.initials: R
authors.lastname: Lanes
authors.forename: Orlando
authors.initials: O
authors.lastname: Jaramillo
mesh_terms: D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D050171:Dyslipidemias / Q000209:etiology; D005260:Female; D006130:Growth Disorders / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D017588:Hyperandrogenism / Q000209:etiology; D006973:Hypertension / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age / Q000254:growth & development*; D007333:Insulin Resistance; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D011627:Puberty; D012016:Reference Values; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D019382:Human Growth Hormone; D008687:Metformin