Three decades of recombinant human growth hormone research in children born small for gestational age: a bibliometric analysis (1996-2025).

BACKGROUND: Recombinant human growth hormone (rhGH) has been a standard therapy for short children born small for gestational age (SGA) since 2001 (FDA) and 2003 (EMA), yet no bibliometric analysis has mapped this field's intellectual structure. MATERIALS AND METHODS: Publications were retrieved from four databases, Lens.org (n = 1,184), OpenAlex (n = 1,343), Web of Science Core Collection (n = 1,121), and Scopus (n = 1,589), yielding 793 unique records after DOI-based merging, therapeutic-relevance filtering, conference-abstract removal, and expert-led relevance auditing, restricted to the 30 complete calendar years 1996-2025. Analyses included publication trends, Bradford's and Lotka's Laws, co-authorship and keyword co-occurrence networks, geographic mapping, citation metrics, open access (OA) trends, keyword trend analysis across three regulatory phases, and transformer-based topic modeling (BERTopic). RESULTS: The field showed three phases temporally aligned with regulatory milestones, stabilizing at a compound annual growth rate (CAGR) of 6.3% (2011-2025). Hormone Research in Paediatrics (n = 107) and the Journal of Clinical Endocrinology & Metabolism (n = 89) were the leading sources. Hokken-Koelega ACS was the most prolific author (n = 81, combining name variants). The United States (n = 115), the Netherlands (n = 111), and Germany (n = 95) led in output across 67 countries. The corpus-level h-index was 66, with 19,415 total citations and a Gini coefficient of 0.69 indicating substantial citation inequality. An unadjusted comparison of citations by open-access status was null (p = 0.86); however, after adjusting for citation age and document type, open-access articles received 2.2-fold more citations than closed-access articles (incidence-rate ratio 2.20, 95% CI 1.84-2.63), an association that attenuated but persisted within journals (1.45). BERTopic identified 7 research themes from 771 abstracts, showing a temporal shift from basic efficacy studies toward molecular and genetic diagnostics (GH-IGF-I axis, Silver-Russell syndrome, genetic short stature) and patient-centered outcomes. Keyword trend analysis across three regulatory phases identified 8 terminological shifts that remained significant after false-discovery-rate correction, including a decline in "IUGR" usage (χ 2 = 66.9, p < 0.001) and a rise in observational/registry studies (χ 2 = 37.6, p < 0.001). CONCLUSION: The rhGH-SGA literature shows a maturing research landscape with increasing thematic diversification from efficacy studies toward molecular and genetic diagnostics and patient-centered outcomes. Keyword trend analysis reveals measurable shifts in terminology, study methodology, and patient populations, identifying gaps and emerging directions that can inform future trial design and funding priorities.