Noeker M
Zentrum für Kinderheilkunde der Universität Bonn.
Klin Padiatr. 2006 Sep-Oct;218(5):249-59. doi: 10.1055/s-2005-836635.
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.
在生长激素治疗（GHT）用于小于胎龄儿（SGA）的治疗指征最近获得批准后，治疗期望不仅涉及生长参数的改善，还包括改善疑似神经认知、行为和教育发育受损情况。然而，临床预后很困难，因为在个体病例中具体会出现哪些发育风险以及这些风险的进程是否会对生长激素治疗产生反应尚不清楚。本文回顾了近期关于小于胎龄儿神经认知和社会心理结局的临床及基于人群研究的发现，并勾勒出一个关于潜在发育风险出现和进程的综合框架，该框架包含三个主要原因：针对身材矮小导致的特定适应困难与全身性、与身材矮小无关的行为障碍进行临床鉴别得出了结论。在与身材矮小相关的特定适应不良程度较高的情况下，社会心理结局参数有望对内分泌生长刺激反应最佳；反之，在存在全身性障碍且与身材矮小无关的情况下，儿童心理干预的相关性会增加。
