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„Small for gestational age“(SGA)-Kleinwuchs

Aktuelle Empfehlungen zur Therapie mit Wachstumshormon

Short children born small for gestational age

Current recommendations on growth hormone therapy

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Zusammenfassung

Neugeborene mit einer sehr niedrigen Geburtslänge oder einem sehr niedrigen Geburtsgewicht, die mehr als 2 Standardabweichungen unterhalb des Durchschnitts eines Vergleichskollektivs gleichen Gestationsalters liegen, sind definitionsgemäß „small for gestational age“ (SGA). Die Ursachen für die zu niedrigen Geburtsmaße sind vielfältig. Bei 90% der Betroffenen normalisieren sich Körpergröße bzw. -länge bis zum Alter von etwa 3 Jahren, 10% bleiben dauerhaft klein (SGA-Kleinwuchs). Das spontane Aufholwachstum nach der Geburt sollte in Relation zur elterlichen Zielgröße beurteilt werden – auch im Hinblick auf die Indikation zur Therapie mit Wachstumshormon (WH). Diese ist in Deutschland seit 2003 zur Förderung des Längenwachstums bei Kindern mit ausgeprägtem SGA-Kleinwuchs und unzureichendem Aufholwachstum zugelassen. Sie sollte frühzeitig, in jedem Fall ausreichend lange vor der Pubertät eingeleitet werden. Kinder, die nicht oder schlecht auf eine WH-Therapie ansprechen, sind meist schon im ersten Behandlungsjahr zu erkennen, die WH-Therapie sollte in diesen Fällen abgebrochen werden.

Abstract

Neonates of short birth length or low birth weight demonstrating more than 2 standard deviations below the average of a comparison group for the same gestational age are referred to as small for gestational age (SGA). The causes of low birth measurements are multifaceted. In 90% of infants affected body length normalizes by 3 years of age, while 10% remain permanently short (SGA short stature). Spontaneous catch-up growth following birth should be evaluated in relation to the parental target height. This also applies to the indication for growth hormone (GH) therapy, which has been approved for use in Germany since 2003 to promote growth in children with pronounced SGA short stature and insufficient catch-up growth. This therapy should be initiated promptly and always at a sufficient interval prior to puberty. Children failing to respond to GH therapy, or responding only poorly, can usually be indentified in the first year of therapy, at which point therapy should be discontinued.

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Danksagung

Wir danken der Firma Novo Nordisk Pharma GmbH, insbesondere Frau Dr. Pfeifer und Herrn Dr. Schmidt, für die Organisation des Workshops.

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin:

Prof. Binder hat Forschungsdrittmittel von den Firmen NovoNordisk und Pfizer sowie Vortragsvergütungen von den Firmen Eli Lilly, Merck Serono, NovoNordisk, Pfizer und Ratiopharm erhalten.

Prof. Brämswig hat Vortragsvergütungen von den Firmen Eli Lilly, Merck Serono, NovoNordisk und Pfizer erhalten.

Prof. Dörr ist Mitglied im wissenschaftlichen Board von KIGS (Pfizer AWB für Genotropin) und hat Vortragsvergütungen von verschiedenen Pharmafirmen erhalten.

Prof. Hauffa hat Beratungshonorare und Vortragsvergütungen der Firmen Pfizer, NovoNordisk und Vortragsvergütungen der Firma Ipsen Pharma erhalten.

PD Dr. Heger hat Vortragsvergütungen von den Firmen NovoNordisk, Ferring und Pfizer erhalten.

Prof. Ranke hat Vortragsvergütungen von den Firmen NovoNordisk, Pfizer und Eli Lilly erhalten. Er ist Mitglied im wissenschaftlichen Board von KIGS (Pfizer AWB für Genotropin).

Dr. Schweizer hat Vortragsvergütungen von den Firmen NovoNordisk und Pfizer erhalten.

PD Dr. Wölfle hat Forschungsdrittmittel von der Firma Pfizer sowie Vortragsvergütungen von den Firmen NovoNordisk, Ipsen und Merck Serono erhalten. Er übt Beratertätigkeit für die Firmen Ipsen und NovoNordisk aus.

Die Autoren und Teilnehmer des Workshops wurden von der Firma NovoNordisk Pharma GmbH eingeladen, die den Workshop am 17.02.2010 in Frankfurt organisierte. Für Präsentationen einzelner Teilnehmer wurde ein Honorar gezahlt, außerdem wurden die Reisekosten für die Teilnehmer übernommen.

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Authors and Affiliations

  1. Pädiatrische Endokrinologie und Diabetologie, Universitätsklinik für Kinder- und Jugendmedizin Tübingen, Hoppe-Seyler-Straße 1, 72076, Tübingen, Deutschland

    G. Binder, M.B. Ranke & R. Schweizer

  2. Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Münster, Deutschland

    J. Brämswig

  3. Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    H.-G. Dörr

  4. Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Essen, Essen, Deutschland

    B.P. Hauffa

  5. Zentrum Kinderheilkunde und Jugendmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland

    S. Heger

  6. Zentrum für Kinderheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland

    J. Wölfle

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  1. G. Binder
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  2. J. Brämswig
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  3. H.-G. Dörr
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  4. B.P. Hauffa
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  5. S. Heger
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  6. M.B. Ranke
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  7. R. Schweizer
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  8. J. Wölfle
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Correspondence to G. Binder.

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Binder, G., Brämswig, J., Dörr, HG. et al. „Small for gestational age“(SGA)-Kleinwuchs. Monatsschr Kinderheilkd 159, 855–862 (2011). https://doi.org/10.1007/s00112-011-2464-9

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