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More than 50 years ago, pediatricians and early “neonatologists” observed that newborns who had birthweights that were statistically less than the 10th percentile or 2 standard deviations below the mean weight for their gestational age experienced unique medical problems. These infants, termed small for gestational age (SGA), had more frequent problems with perinatal depression (“asphyxia”), hypothermia, hypoglycemia, polycythemia, long-term deficits in growth, and neurodevelopmental handicaps and higher rates of fetal and neonatal mortality (Fig. 1 ). Despite improvements in perinatal diagnosis and treatment, SGA infants are still born regularly (more frequently in underdeveloped countries, but also in the United States and other developed areas), and their perinatal morbidity and mortality rates continue to exceed those of normal fetuses and infants.

As the specific morbidities associated with SGA infants were recognized, relatively standardized approaches to their evaluation and clinical management were established....

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