Study Finds Infants Born Small for Gestational Age Achieve Adequate Catch-Up Growth Without Growth Hormone Therapy

Mother measuring son’s height and marking it with pencil on door. Nikon D810
A team of investigators sought to determine the incidence of infants born small for gestational age and assess the timing of their catch-up growth.

Analysis of newborn registries at 2 hospitals in Israel found there were fewer infants born small for gestational age (SGA) than expected and most achieved adequate catch-up growth, according to the results of a study published in Clinical Endocrinology.

All babies born at Hadassah hospitals during 4 consecutive years (N=43,307) were assessed for SGA status as defined by both the World Health Organization and Israeli Ministry of Health criteria (birth weight <2 standard deviations [SD] from the mean). Infants who were determined to be SGA were followed up to year 8 to assess adequate catch-up growth, which was defined as length or height greater than -2 or -2.5 SD from the mean.

The infants were born at a median gestational age of 38.89 weeks; 8.2% were preterm, and 28.9% were primigravida births.

A total of 524 (1.2%) infants were determined to be SGA. The rate of SGA status was consistent over the 4-year period, corresponding with 120 SGA infants per 10,000 births. Based on previous data, this SGA rate was only 53% of the expected rate of 230 SGA infant births.

Among infants who were SGA, 5.1% had diseases that were associated with compromised growth (eg, genetic abnormalities, malformations, gastrointestinal diseases, and metabolic/endocrine diseases).

The vast majority of babies born as SGA (90.8%) achieved adequate catch-up growth by year 8, and 96% achieved adequate growth in height by 5 years of age, indicating that most children born SGA were not eligible for growth hormone supplementation.

Stratified by gestational age at birth, fewer children born preterm vs term achieved a catch-up growth rate -2 SD (69.8% vs 93.6%; P <.001) or -2.5 SD (86.8% vs 97.2%; P <.001).

Among the 18 children not achieving adequate catch-up growth, more than half (61%) had serious diseases. Of all children born during a 4-year period without serious diseases, only 7 did not achieve adequate catch-up growth.

A limitation of this study is that determination of SGA status at birth was only based on birth weight as measurements of birth length can be inconsistent and variable.

The authors caution that “postnatal preventive care practices and routine assessments should be modified accordingly, in order to either prevent unnecessary monitoring and treatment or to identify and manage complications of this high-risk population.”


Lavi E, Shafrir A, Halloun R, et al. Eligibility for growth hormone therapy in children born small for gestational age is substantially lower than expected. Clin Endocrinol. Published online April 22, 2021. doi:10.1111/cen.14489