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

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.

Patients' Perception of the Use of the EasyPod™ Growth Hormone Injector Device and Impact on Injection Adherence: A Multi-Center Regional Study.

Objective: This study aimed to assess patient perceptions of the use of the EasyPod™ growth hormone delivery device and its association with compliance. Methods: This cross-sectional, multicenter study was conducted in six centers from three countries (United Arab Emirates, Oman, and Saudi Arabia,) between March 2020 and June 2020. Children and adolescents aged 3-18 years, diagnosed with growth disorders and receiving rhGH through the EasyPod™ device were enrolled. Patients and caregivers were given a pre-set questionnaire that evaluated patient satisfaction, preference for technical and personalized features, and device drawbacks. The results were analyzed using independent measures of analysis of variance to evaluate the association of higher satisfaction with device features and better compliance. Results: A total of 186 patients were enrolled in the study. Of these, 45.7% had GH deficiency. The mean age (±SD) of patients was 11.8 (±2.76) years; 117 (62.90%) were males. Average compliance was 87%. One hundred patients (53.76%) had injection compliance of ≥90%. Amongst these patients, 74%, 68%, and 77% top-scored (5/5) the technical features of hidden needle, skin sensor, and pre-set dosing, respectively, compared to top scores by 39%, 34%, and 51% patients in the <90% compliance group (p-value <0.05). Similarly, a statistically significant difference was observed between the groups (p-value <0.05) in the perception of the usefulness of the tracking features such as display of history of injected doses (78% vs. 47.7%), a reminder for medicine remaining (46% vs. 23.3%) and battery power indicator (48% vs. 20.9%). Personal screen messages were associated with higher compliance while the requirement to keep the device in the fridge was reported as the most inconvenient feature by 56% of patients in the higher compliance group as against 39.5% in the lower compliance group (p-value <0.05). There was no statistically significant difference in the intensity of pain reported in the two compliance groups. Conclusion: Our study showed that there is a statistically significant association between better perception of device features and higher compliance.

The growth hormone-insulin-like growth factor-I axis in the diagnosis and treatment of growth disorders.

The growth hormone (GH)-insulin-like growth factor (IGF)-I axis is a key endocrine mechanism regulating linear growth in children. While paediatricians have a good knowledge of GH secretion and assessment, understanding and use of measurements of the components of the IGF system are less current in clinical practice. The physiological function of this axis is to increase the anabolic cellular processes of protein synthesis and mitosis, and reduction of apoptosis, with each being regulated in the appropriate target tissue. Measurement of serum IGF-I and IGF-binding protein (IGFBP)-3 concentrations can complement assessment of GH status in the investigation of short stature and contribute to prediction of growth response during GH therapy. IGF-I monitoring during GH therapy also informs the clinician about adherence and provides a safety reference to avoid over-dosing during long-term management.

Growth reference for Saudi preschool children: LMS parameters and percentiles.

BACKGROUND: Previous growth charts for Saudi children have not included detailed tables and parameters needed for research and incorporation in electronic records. OBJECTIVES: The objective of this report is to publish the L, M, and S parameters and percentiles as well as the corresponding growth charts for Saudi preschool children. DESIGN: Community-based survey and measurement of growth parameters in a sample selected by a multistage probability procedure. SETTING: A stratified listing of the Saudi population. SUBJECTS AND METHODS: Raw data from the previous nationally-representative sample were reanalyzed using the Lambda-Mu-Sigma (LMS) methodology to calculate the L, M, and S parameters of percentiles (from 3rd to 97th) for weight, length/height, head circumference, and body mass index-for-age, and weight for-length/height for boys and girls from birth to 60 months. MAIN OUTCOME MEASURES: Length or height and weight of Saudi preschool children. RESULTS: There were 15601 Saudi children younger than 60 months of age, 7896 (50.6 %) were boys. The LMS parameters for weight for age from birth to 60 months (5 years) are reported for the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles as well as the corresponding graphs. Similarly, the LMS parameters for length/height-for-age, head circumference-for-age, weight-for-length/height and body mass index-for-age (BMi) are shown with the corresponding graphs for boys and girls. CONCLUSION: Using the data in this report, clinicians and researchers can assess the growth of Saudi preschool children. LIMITATIONS: The report does not reflect interregional variations in growth.

Prevalence of selected congenital anomalies in Saudi children: a community-based study.

BACKGROUND AND OBJECTIVES: Limited data are available on the prevalence of congenital anomalies based on a community survey in Middle East countries. The prevalence of congenital anomalies is expected to be high in these countries because of the high consanguinity rate and high maternal age. The aim of this cross-sectional study was to establish the prevalence of congenital anomalies in Saudi Arab children. DESIGN AND SETTINGS: This is a prospective, cross-sectional, community-based study conducted over 2 years among the Saudi population. SUBJECTS AND METHODS: The study sample was determined by a multi-stage probability random sampling of household representatives of the Saudi Arab population. The health status of children was obtained during household visits by primary care physicians who performed a history and physical examination of all children and adolescents younger than 19 years. All cases of congenital anomalies were recorded. RESULTS: During the 2-year study period (2004-2005), a total of 45 682 children were screened. The commonest congenital anomalies found in this survey were Down syndrome, congenital deafness, and congenital blindness with prevalence rates of 6.6 per 10 000, 4.8 per 10000, and 1.3 per 10000 children, respectively. The prevalence of cleft lip with or without cleft palate was 0.9 per 10000 children, achondroplasia was 0.7 per 10000, and Dandy-Walker syndrome was 0.4 per 10000. Crouzon syndrome, Treacher-Collins syndrome, Angelman syndrome, and Turner syndrome had equal prevalence of 0.2 per 10000 children. CONCLUSION: The data suggest a significant decline in the prevalence of Down syndrome; however, the prevalence of other anomalies like congenital deafness is still high.