[Neurocognitive and psychosocial development in SGA and the indication for growth hormone therapy]

Abstract

After recent approval of treatment indication for growth hormone therapy (GHT) in SGA (small for gestational age) treatment expectations do not only refer to improvement of growth parameters but also to enhancement of suspected impairments of neurocognitive, behavioural and educational development. Clinical prognosis, however, is difficult which specific developmental risks are to be expected in the individual case and if their course may response to GHT. The paper reviews recent findings of clinical and population-based studies on neurocognitive and psychosocial outcome in SGA and delineates an integrative framework on the emergence and course of potential developmental risk comprising three major causes: Conclusions are drawn for the clinical differentiation of specific adaptation difficulties towards short stature versus global, short stature independent behavioral disorders. Psychosocial outcome parameters can be expected to respond best to endocrinological growth stimulation in conditions with a high specific short stature related maladjustment; in turn, the relevance of child psychology interventions increases in conditions with global disturbance and short stature independent origin.