Introduction and aims Assessing pubertal growth is complex, due to variation in age when puberty begins. We have developed a new puberty phase specific (PPS) growth reference, constructed using Dutch national cross-sectional data, recalibrated to match the UK 1990 reference. It uses Tanner staging simplified into three phases: Pre puberty (Tanner stage 1), In puberty (2 and 3) and Completing puberty (4 and 5). The aim of this analysis was to assess the validity of the PPS reference when applied to UK children, and the impact its use might have on the assessment of pubertal growth. Subjects and method We used the Chard data set: longitudinal height and weight data collected on 124 healthy UK children from 1981 to 1988 for ages 8.3-16.6 years. There were 1-14 measurement occasions per child, 1,252 in total, all with exact age and Tanner pubertal staging. All measures were converted into SD scores (SDS) based on the UK90 reference and the new PPS reference. Results Within each phase, the measurements fitted closely to the PPS reference (mean height SDS by phase: Pre 0.1, In 0.1, Completing 0.3; mean weight SDS: Pre −0.1, In 0.1, Completing 0.1); PPS SDS showed little trend with age in each phase, in contrast to UK90 where the SDS fell significantly (see table 1). Abstract G185 Table 1 Correlations with age Pre Puberty In Puberty Completing Puberty PPS Height SDS 0.02 −0.04 0.05 Weight SDS −0.02 −0.08+ 0.04 Uk 1990 Height SDS −0.17** −0.32*** −0.22*** Weight SDS −0.22*** −0.35*** −0.22*** + P <0.1 **P <0.01 *** P<0.001 For 72 children with measurements in both the Pre and Completing phases, a change of more than one centile space (0.67 SDS) over time was seen in only 15% (11) for PPS height SDS and only 26% (17) for PPS weight SDS. Conclusions Children entering puberty relatively late tend to appear shorter and lighter based on the conventional UK90 chart, but do not when compared to a reference that adjusts for phase of puberty. The PPS reference shows a good fit to UK children and should allow growth though puberty to be tracked more accurately.
A new liquid formulation of hGH (Norditropin SimpleXx) has been developed to avoid the need for reconstitution before administration. In addition, the liquid GH formulation has been combined with an advanced pen delivery system, either with or without a needle auto-insertion mechanism. This study was designed to assess the acceptability of the new system compared with the patient's previous system. A total of 103 children with GH deficiency received a daily injection of Norditropin liquid GH for 12 weeks with a choice of a pen/auto-insertion system. Acceptability was determined by nurse-supervised questionnaires administered to the patients and parents. Following treatment, 94% of patients preferred the Norditropin liquid GH system. This preference was irrespective of the previous system in use, patient age or length of GH therapy. More patients found it the less painful system (50% vs 13%), 92% of patients found it more convenient, and the formulation was well tolerated. In conclusion, Norditropin liquid GH was very well accepted and preferred by the majority of patients. It avoided reconstitution which had been a major cause of dissatisfaction with the patients' previous systems, and resulted in greater convenience and reduced levels of pain associated with injection.
Background and aims Assessing growth around puberty is difficult and children with later onset of puberty may be mislabelled as abnormal. When designing new school age charts a lower pubertally adjusted (PA) 0.4th centile was added to the prototype chart for children aged 8-13 still in pre-puberty, with shading between this and the standard 0.4th centile. We aimed to evaluate users' understanding of this feature and its impact on clinical judgement. Methods Three workshops were performed with GP trainees (N=26) and paediatricians (N=48). After explanatory slides about the new charts, participants completed workbooks which tested aspects of the new charts using plotting and interpretation. These included two standardised scenarios where a height at 11 years was in the shaded area between the conventional and the PA 0.4th centile. One was a pre-pubertal girl growing steadily within the PA normal range and the other a girl in-puberty with declining growth, dropping below the PA 0.4th centile. These were permutated through two questionnaires, with each respondent viewing only one. Results The pubertal phase was reported correctly by 93% of the 74 respondents. Only 61% (23) viewing the pre-pubertal child recognised that she was above the PA 0.4th centile, though 79% (30) recognised she required no further investigation. Of those viewing the pubertal child 31% (11) incorrectly stated that she was above the PA 0.4th centile and only 47% (17) recognised she required further investigation. In 2/3 sessions more specific questions were asked about centile position and 88% (42/48) correctly reported the unadjusted centile position (<0.4th). Of these, only 10/18 then recognised that the pre-pubertal child was above PA 0.4th centile while 5/20 incorrectly stated that the in-puberty child was on or above the PA 0.4th centile. Unfavourable comments, describing the pubertal element as complex and confusing were made by 49% respondents. Conclusions The proposed shaded area was ineffective at identifying lower risk children and seemed to create false reassurance concerning children with disordered growth in puberty, so the design has now been radically modified. This study shows that formal evaluation of ‘improvements’ to growth charts is essential.
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