In response to the Letter to the Editor from Arroyo et al (1), we find it reassuring that an article by Arroyo et al (2) published at the exact same time as our study (3) (April 2022) showed a similar growth pattern and adult height for children born small for gestational age (SGA) as we did, especially with a decrease in height gain at puberty. We believe that the minor differences in gain in adult height between these similar sized cohorts (n = 61 in the Arroyo cohort vs n = 47 in our cohort) may reflect the heterogeneity found in general in cohorts of children born SGA.

The study by Arroyo et al found no difference in age of onset at puberty whereas we found that the onset of puberty assessed by a puberty nomogram (4) was advanced in boys, but pubertal onset was still within the normal range compared with the reference population in both studies.

We certainly agree that the differences found in the studies on growth response and adult height following growth hormone treatment in children born SGA reflects the heterogeneity of the SGA population. Thus, we agree that it would be helpful with large clinical trials that could help us generate predictive variables of response to GH treatment in SGA children.