Saturday, August 23, 2008

Small For Gestational Age : Issues in 2008

My Solitude Of Space
There is a solitude of space. A solitude of sea. A solitude of death, but these Society shall be, Compared with that profounder site, That polar privacy. A soul admitted to itself- Finite infinity.

Saturday, 23 August 2008
Small For Gestational Age : Issues in 2008

Small for gestational age (SGA) infants account for about 10% of all live births. While the majority of these children show catch-up growth by 2 years of age, approximately 15% do not and continue to experience poor growth throughout childhood.

The major cause of morbidity and mortality in infancy and childhood is low birth weight. Additionally, children born SGA show an increased mortality from a wide range of disorders, including coronary artery disease and stroke later in life.

Children born SGA have also been shown to have a lower cognitive ability in mathematics and in reading comprehension. Those children who do not experience catch-up growth in height or head circumference exhibit the worst outcome.

First of all, why is size at birth important? I have three reasons here. To start off life, size at birth is predictive for perinatal mortality and morbidity. This graph shows one of the earliest studies to show this relationship between birth weight, lower birth weight, and increased mortality. While, of course, the absolute mortality rates are much lower these days, the same associations with birth weights are also seen.

Slide 5.
Secondly, at the end of childhood, low birth weight is important for adult height, and particularly, low-birth-weight children who do not catch up within the first few years of life remain small as adults. This is clearly exemplified by the control groups of recent, very long-term published results of growth hormone trials. Here you can see the control group does not show any spontaneous catch-up at all from early childhood through to adult life.

Slide 6.
In the next talk, you will hear much more about the association between low birth weight and increased risk of adult diseases, such as coronary heart disease and type 2 diabetes.

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