The small for gestational age (SGA) child is one born with a weight and / or length below the 3rd percentile adjusted for gestational age. And it is not that the child grows up to be shorter than his classmates, because these children usually hit the stretch. The real problem It is that a child who was SGA at birth has a risk of suffering from cardiovascular disease similar to that caused by tobacco use in adulthood. In addition, they are more inclined to suffer from disorders metabolic, neurological and growth that should be watched carefully.
“Indeed, it is not only a matter of monitoring the child’s height or weight when he grows up. In fact, up to 80 percent of SGA children make recuperative growth in the first two years of life. But the clinical risks do not disappear and it is key to maintain monitoring throughout their pediatric age, until puberty and adolescence. In the beginning, parents are alarmed, but as soon as they see that the child registers the normal percentile, they forget. However, the risks associated with being born SGA are still there and may even worsen, if the recovery of normal values has been abrupt and fast, ”explains Marta López Capapé, head of the Multidisciplinary Follow-up Unit of the SGA child of the
Sanitas La Moraleja University Hospital.
This specialist cites a recent study published in the Spanish Journal of Pediatric Endocrinology, which establishes the direct relationship between being a SGA child and having cardiovascular disease. Being born with less weight and height thus becomes a risk similar to the consumption of tobacco that causes endothelial dysfunction and later coronary disease and / or cerebrovascular accidents. Yes, this initial condition would need the addition of other environmental risk factors such as obesity, a diet rich in saturated fat, a sedentary lifestyle, stress and, of course, the aforementioned tobacco, to finally generate cardiovascular disease. Hence the importance of medium and long-term follow-up and prevention with the establishment of healthy habits from an early age.
Only in Spain, 3-7% of newborns are small for gestational age. This translates, according to the National Institute of Statistics, into some 27,000 children who are at higher risk of suffering from health disorders. «These children can present different clinical pictures. From the outset, when they are babies, they can suffer from poor digestive tolerance or hypoglycemia. In childhood and adolescence, they may present with attention deficit and hyperactivity, as well as a possible deterioration of the IQ. They can also suffer from metabolic syndrome, with high cholesterol and arterial hypertension and, ultimately, delayed bone maturation combined with a rapidly evolving pubertal advancement that compromises their adult size ”, the specialist has remarked.
That is why it is essential that parents are correctly informed and remain alert, in addition to ensuring the clinical follow-up of a SGA child.
The medical challenge for an adequate follow-up of this type of patient is remarkable. “It is a team effort in which we participate in neonatologists, endocrinologists, neurologists and nephrologists, among others. The protocol of our unit begins with an initial evaluation of the newborn in the Neononatology consultation and a twelve-month review in which the rest of the specialists take part. From there, the reviews would be done every 2 years, until the minor reaches 10 years. And yes, I recognize that it is not the ideal situation for any parent, but the benefits of monitoring are so many! “, Says Dr. López Capapé.
Follow-up programs are common in the field of pregnant women and even in the vaccination coverage of children, but in the field of SGA children, there is little awareness of the need to respond to the health problems that these may experience kids: “The risks we are talking about are important and we cannot underestimate them. Mainly because they can be treated, as, for example, adult short stature through growth hormone; or learning disorders, through an early neurological approach, or in short the metabolic disorder, which can be fought through healthy habits from a very young age “, the specialist concluded.