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Growth Hormone Treatment in Very Young Children Born Small for Gestational Age« Back to Volume 24, Issue 1, May 2008 - Table of Contents Argente and colleagues analyzed the outcome of growth hormone (GH) treatment in a large group of very young children born small for gestational age (SGA). They evaluated 76 children, recruited from 14 public hospitals in Spain, aged 2 to 5 years (37 males and 39 females; 45% less than 4 years of age) born SGA without catch-up growth during their first 2 years of life. The results after 24 months of GH treatment (0.06 mg/kg/day for 2 years, group I) were compared with those of a control group without treatment for 12 months, followed by 12 months of GH therapy (group II). The mean height SDS gain for chronological age in group I children was 2.10, compared to 1.43 in the children of group II. Height SDS for bone age was significantly different between groups only when group II did not receive GH treatment. Growth velocity SDS increased from –2.2 at baseline to 4.7 at 12 months in group I, while no significant changes from baseline values were noted in untreated group II subjects. Children in both groups under 4 years of age had the greatest gain in growth velocity, not only in SDS but also in their absolute increase in centimeters; weight SDS followed the same pattern (Figure). The BMI SDS did not change significantly during the study period and there was no significant acceleration of bone age. Fasting blood glucose, insulin, and HbA1c levels remained within the normal range and with no difference among groups throughout the study. Both insulin-like growth factor (IGF)-I and IGF binding protein (IGFBP)-3 increased significantly after 6 months of GH therapy and remained at a similar level thereafter, but did not exceed +2 SDS for chronological age during the study period. Editor’s CommentNearly 3% of infants are born SGA–that is with a weight and/or length at least 2 SD below the mean for gestational age. Most of these children undergo catch-up growth, allowing them to reach normal height by 2 years of age. However, close to 10% of SGA children fail to achieve an appropriate catch-up growth and remain short throughout childhood with a height below –2 SD. As demonstrated by a number of recent studies,1,2 when treated with GH these patients can normalize their height during childhood, are able to maintain a normal growth velocity while prepubertal and during puberty, and can attain a normal adult height. Treatment with GH seems to be useful even in non-GH deficient SGA children and in those in whom no detectable cause for the lack of catch-up growth can be detected. However, most studies performed so far have been completed in older SGA children, so that the safety and efficacy of GH treatment in young children born SGA is unknown. In this study by Argente et al it was demonstrated that very young SGA children with no spontaneous catch-up growth during the first 2 years of life are able to significantly increase their growth velocity and their height SDS following 2 years of GH therapy. However, continuously high plasma IGF-I and IGFBP-3 levels during therapy were evident. If these persist for years there may be potentially harmful effects.3 The increase in growth velocity was greatest in SGA patients. Whether early GH treatment will result in a significantly greater adult height in these patients remains to be determined by long-term follow-up, but these observations seem to suggest the benefits and safety of early GH therapy in short children born SGA. Roberto Lanes, MD References - (linked to
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Volume 26 Number 1
September 2010
www.GGHjournal.com
ISSN 1932-9032
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