Growth Hormone Treatment of the Short Child Born Small for Gestational Age

Intrauterine growth retardation (IUGR) is a pathologic condition where fetal growth is restrained by either extrinsic (maternal, placental, or environmental) factors or a disorder intrinsic to the fetus itself. This is a significant problem because of the morbidity that accompanies IUGR, which includes persistent short stature. Although most children born small for gestational age (SGA) have accelerated growth following birth and reach a height in the normal range, about one in ten remain short. The explanation for the lack of catch-up growth in these individuals remains unclear. Nevertheless, when treated with exogenous growth hormone at supraphysiologic doses, accelerated growth is observed and adult height is increased. These data led worldwide regulatory agencies to approve recombinant human growth hormone (rhGH) for the treatment of short stature in children born SGA without the expected postnatal catch-up growth. The effect of IUGR on subsequent growth, its amelioration by growth hormone, and the approach for the evaluation and treatment of the individual patient are the focus of this chapter.