ESPE Abstracts

Introduction: Worldwide the incidence of small for gestational age (SGA) births varies between 2 and 10%. In Bulgaria there is not enough data for the SGA births prevalence in the last 20 years. There is only one population based study focused on late SGA complications that found the world-known relative share of SGA children who don’t catch up - about 10%. The indicated growth hormone treatment is still not reimbursed in the country for short SGA children. The unmet need of faster detection and proper follow-up of such children was evident.

Aim: The aimof the study is to assess the possibility for early detection and systematic follow-up of SGA children through a structured Programme.

Materials and Methods: After clearance from the University Ethical Committee, the project was established at 23 maternities for 1 year (2021-2022). Full-term and premature SGA newborns were eligible for participation except severely sick at birth children. The potential participants were identified by the local neonatologists based on the 10^th percentile for birth weight and length of the Fenton growth reference. Two Programme coordinators had the task to gather data every month from the participating neonatology structures and assess implementation rate. Each family that signed informed consent (IC), was enrolled in the second stage of the Programme consisting of follow-up by pediatric endocrinologist at least once at 2 years of age.

Results: Two of the maternities didn`t start work at all. After the first six months, one additional clinic was enrolled and two other maternities were excluded from the Programme thus leaving 20 active maternities. A total of 794 SGA children were detected, 3.2 % of all births, and 443 (55.8%) signed IC. The prevalence differed in the country. Three structures (13.6%) found between 8.7 and 10.9% SGA births that corresponded to the expected incidence. One neonatology clinic that was not situated at an Obstetrics hospital found 4.8% SGA newborns that is higher than all the other units in the same city. The time needed for the inclusion of 1 newborn in the Programme was estimated at 7 to 10 min at the maternities where all children were properly assessed and where the whole staff was involved in the Programme. Barriers and facilitators were strictly recorded, explored and at least partly corrected in real time.

Conclucsion: The Programme proved its potential, and further suggested the need for standardized approach in order to detect and follow-up SGA children.