Breastfeeding in SGA Neonates: “Does It Promote Healthier Growth Patterns?”

Background: Small for Gestational Age (SGA) neonates, characterized by birth weight and/or length below the 10th percentile for gestational age, face heightened risks of growth failure, or abnormal growth patterns along with and metabolic complications and developmental delays. Breastfeeding has been identified as a critical factor in promoting healthier growth and mitigating long-term health risks in both fullterm and preterm appropriate for gestational age (AGA) infants but similar studies in SGA infants are limited. Aim: This study reviewed the impact of breastfeeding on growth, and body composition in SGA neonates. Patients and methods: Using PubMed and Google Scholar 38 relevant studies, were identified, with 13 included in the final analysis, encompassing systematic reviews, randomized controlled trials, observational studies, and narrative reviews. Results: In preterm SGA neonates, exclusive human milk-based diets demonstrated superior outcomes compared to formula-based diets. Human milk promoted healthier catch-up growth without excessive fat accumulation along with reduced neonatal morbidities such as necrotizing enterocolitis, sepsis, and bronchopulmonary dysplasia. Advanced body composition methods, such as dual-energy X-ray absorptiometry (DXA), confirmed the protective metabolic benefits of human milk. Fortification strategies were found to enhance growth outcomes in donor milk-fed infants. For fullterm SGA neonates, exclusive breastfeeding for six months was associated with healthy catch-up growth without predisposing infants to obesity or excessive fat accumulation. Breastfed SGA infants exhibited normal or reduced adiposity, and favourable endocrine profiles. Conclusion: breastfeeding consistently emerged as a protective factor for SGA neonates, promoting healthier growth patterns. Further high-quality studies are needed to corroborate the observed patterns.