International Consensus Guideline on Small for Gestational Age: Etiology and Management From Infancy to Early Adulthood.

IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Endocrine reviews Pub Date : 2023-05-08 DOI:10.1210/endrev/bnad002
Anita C S Hokken-Koelega, Manouk van der Steen, Margaret C S Boguszewski, Stefano Cianfarani, Jovanna Dahlgren, Reiko Horikawa, Veronica Mericq, Robert Rapaport, Abdullah Alherbish, Debora Braslavsky, Evangelia Charmandari, Steven D Chernausek, Wayne S Cutfield, Andrew Dauber, Asma Deeb, Wesley J Goedegebuure, Paul L Hofman, Elvira Isganatis, Alexander A Jorge, Christina Kanaka-Gantenbein, Kenichi Kashimada, Vaman Khadilkar, Xiao-Ping Luo, Sarah Mathai, Yuya Nakano, Mabel Yau
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引用次数: 11

Abstract

This International Consensus Guideline was developed by experts in the field of small for gestational age (SGA) of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Further, it presents long-term consequences of SGA birth and also reviews new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, as well as the metabolic and cardiovascular health of young adults born SGA after cessation of childhood GH treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardiometabolic health profile in adulthood. Children born SGA with persistent short stature < -2.5 SDS at age 2 years or < -2 SDS at 3 to 4 years of age, should be referred for diagnostic workup. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability, and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033 to 0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3 to 4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle.

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胎龄小的国际共识指南:从婴儿期到成年早期的病因和管理。
本国际共识指南是由全球10个儿科内分泌学会的小胎龄(SGA)领域的专家制定的。举行了协商一致意见会议,1300条条款构成了讨论的基础。所有专家都对这些建议的优点进行了投票。该指南为SGA出生后身材矮小的病因学提供了新的和临床相关的见解,包括关于(epi)遗传原因的新知识。此外,它还介绍了SGA出生的长期后果,并回顾了新的治疗选择,包括促性腺激素释放激素激动剂(GnRHa)治疗和生长激素(GH)治疗,以及与适当对照组相比,停止儿童GH治疗后出生的SGA年轻人的代谢和心血管健康。为了诊断SGA,建议使用准确的人体测量和国家生长图。早期随访是必要的,并对那些有风险的人进行神经发育评估。应避免过度的产后体重增加,因为这与成年后不利的心脏代谢健康状况有关。出生SGA的儿童在2岁时持续身高小于-2.5 SDS或在3至4岁时持续身高小于-2 SDS,应进行诊断性检查。对于畸形特征、严重畸形、小头畸形、发育迟缓、智力残疾和/或骨骼发育不良的迹象,应考虑进行基因检测。对于3 ~ 4岁持续身材矮小的患者,建议使用0.033 ~ 0.067 mg GH/kg/天。当青春期开始时预期成人身高较矮时,可以考虑添加GnRHa治疗。所有出生在SGA的年轻人都需要接受健康生活方式的咨询。
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来源期刊
Endocrine reviews
Endocrine reviews 医学-内分泌学与代谢
CiteScore
42.00
自引率
1.00%
发文量
29
期刊介绍: Endocrine Reviews, published bimonthly, features concise timely reviews updating key mechanistic and clinical concepts, alongside comprehensive, authoritative articles covering both experimental and clinical endocrinology themes. The journal considers topics informing clinical practice based on emerging and established evidence from clinical research. It also reviews advances in endocrine science stemming from studies in cell biology, immunology, pharmacology, genetics, molecular biology, neuroscience, reproductive medicine, and pediatric endocrinology.
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