I. Diagnosis of small for gestational age children with dwarfism and indications for rhGH treatment
Small for gestational age (SGA) refers to newborns with birth weight and/or length below the 10th percentile of the mean for the same gestational age or 2 standard deviations (SD) below the mean, and are commonly termed small for gestational age, with weight < 2.5 kg or length ≤ 47 cm. The incidence of SGA is 3-10%, with 10-15% of children without catch-up growth, and about half of these children with growth disorders eventually develop adult short stature.
In July 2001, the U.S. Food and Drug Administration (FDA) approved recombinant human growth hormone (rhGH) for the growth-promoting treatment of children with SGA dwarfism who have not reached normal height by age 2. The results of foreign studies confirm that long-term treatment with rhGH is effective in improving the final adult height of children with SGA dwarfism.
II. Tests that should be done before rhGH treatment for children with dwarfism younger than fetal age
1) Detailed medical history
1) Birth history: length and weight at birth, history of asphyxia and obstructed labor
2) Annual growth rate
3) Family history: family height, any chronic diseases
2) Physical examination
Height, finger spacing, sitting height, weight, blood pressure, spine, deformities, and if there is growth delay, intelligence test should be performed.
3) Laboratory tests
1) Thyroid function (those with hypothyroidism should be treated with hypothyroidism for at least 3 months before treatment with GH)
2) Liver function (to exclude liver disorders)
3) Kidney function (to exclude kidney disease)
4) Glucose metabolism indexes: blood glucose (use rhGH treatment carefully if you have hyperglycemia), blood insulin and glycated hemoglobin.
5) Blood lipids
6) Female chromosome examination
7) GH/IGF-I axis functional status: blood IGF-I and blood IGFBP-3
8) Blood and urine routine (rhGH therapy is contraindicated in suspected early stage leukemia)
9) CT or MRI of hypothalamus and pituitary gland (rhGH therapy is contraindicated in cases with suspicion of occupational lesions)
10) If growth retardation is present, intelligence should be measured and EEG should be performed
11) Blood cortisol and ACTH test
12) Electrocardiogram should be done if necessary.
III. Tests that should be done during rhGH treatment for children with dwarfism less than fetal age
Follow up at 3, 6, 9 and 12 months after rhGH injection (it is recommended to follow up every 3 months and to consult the doctor at any time if there is any abnormal reaction).
1.Observe the injection site for redness, swelling, hard nodules, and any systemic adverse reactions of various systems.
2.Measure height regularly, fixed at a specific time of the day (preferably in the early morning, not at night before going to bed), with a person in charge, using a fixed apparatus (fine-style ruler).
3.Measure blood pressure regularly.
4.Follow up records of laboratory tests after rhGH treatment.