Background Young children with CAH require small doses (0.1-1.25 mg) of hydrocortisone (HC) to control excess androgen production and avoid the negative effects of overtreatment. The smallest commercially available HC formulation, before the recent FDA approval of HC granules, was a scored 5 mg tablet. The options to achieve small doses were limited to using a pharmacy-compounded suspension, which the CAH Clinical Practice Guidelines recommended against, or splitting tablets into quarters or eighths, or dissolving tablets into water. Methods Cross sectional chart review of 130 children with classic CAH treated with tablets versus a pharmacy-compounded alcohol-free hydrocortisone suspension to compare growth, weight, skeletal maturation, total daily HC dose and exposure over the first four years of life. Results No significant differences were found in height, weight, or BMI z-scores at 4 years, and in predicted adult height, before or after adjusting for age at diagnosis and sex. Bone age z-scores averaged 2.8 SDs lower for patients on HC suspension compared to HC tablets (p<0.001) after adjusting for age at diagnosis and sex. The suspension group received 30.4% lower (p>0.001) average cumulative HC doses by their 4th birthday. Conclusions Our data indicates that treatment with alcohol-free HC suspension decreased androgen exposure as shown by lower bone age z-scores, allowed lower average and cumulative daily HC dose compared to HC tablets, and generated no significant differences in SDS in growth parameters in children with CAH at 4 years of age. Longitudinal studies of treating with smaller HC doses during childhood are needed.
Introduction: Tablets and smartphones have become ubiquitous in the lives of young children. Literature from developed countries has shown both positive and negative long-term effects of screen exposure and use on developmental milestones; however, no information is available for developing countries. This study assesses the prevalence of device use among children 2 years and younger and parent perception of the impact of these devices.Methods: Parents of healthy children (≤ 2 years) were approached at an out-patient pediatric clinic in an urban teaching hospital between May-July 2016. After consenting, parents were asked to interview with one of the investigators based on a 40-item questionnaire divided into 4 main sections: demographics, availability and accessibility of portable devices, use of devices and parents' perception.Results: 71 questionnaires were analyzed. Most families lived in urban areas (73%) and at least one parent was university-educated (82%). All households had at least 1 media device; 65% of children were allowed to use devices before the age of 2-28% independently. Most children (62%) were allowed access for <1 hour/day:25% for entertainment, most commonly YouTube (54%). Majority of parents (80%) believed the use of portable media devices had a negative impact on their child, yet 60% perceived their children were calmer when using them and 44% got irritated when devices were taken away. Conclusion:Among well-educated urban families in a developing country, exposure of children to mobile media devices starts as early as infancy, despite parental perception of their potentially negative impact on the child.
Young children with CAH require small doses (0.1–1.25mg) and incremental adjustments of hydrocortisone (HC) to control excess androgen production and avoid the negative effects of overtreatment. A recent 6 hour pharmacokinetic/pharmacodynamic study reported that alcohol-free HC suspension provides similar cortisol exposure to tablets (1), but more data is needed to assess its clinical efficacy. We performed a chart review to determine the effect of the alcohol-free HC suspension compared to tablets on height, weight, BMI, bone age z-scores and corrected height z-scores to target height z-scores in children aged 2 yrs and 4 yrs in a cohort with classic CAH. Independent 2-sample t-tests examined cumulative and average HC dose at 2 and 4 yrs. Triple logistic modeling of longitudinal heights were used to calculate predicted near-adult height. Adjusted linear regression models assessed the effect of HC suspension compared to tablets on final adult height. Charts of 130 children (70 females, 100 salt wasting and 30 simple virilizing) were reviewed. At 2 yrs, 97 were treated with tablets and 33 with suspension (17 previously switched from tablets). At 4 yrs, 89 were treated with tablets and 41 with suspension (25 switched). No significant differences in height or BMI z-scores at both 2 and 4 yrs, before or after adjusting for age at diagnosis and sex were found. Bone age z-scores averaged 7.2 SDs lower for patients treated with HC suspension only compared to patients on HC tablets at age 4 (p<0.001), and 5.93 SDs lower for patients switched from tablets to suspension compared to tablets (p<0.001). The suspension group received 16% lower (p=0.055) and 25% lower (p=0.002) cumulative HC doses by the ages of 2 yrs and 4 yrs respectively. Average daily HC dose was lower by 3.44 and by 4.46 mg/m2/d over the first 2 and 4 yrs of life respectively. No significant differences were found between patients treated with tablets and suspension in the predicted final adult height, its z-score or its corrected z-score to target height after adjusting for age at diagnosis, sex and diagnosis. Our data indicates that treatment with alcohol-free HC suspension decreased androgen exposure as shown by lower bone age z-scores, generated no significant differences in SDS in observed height, BMI or predicted near-adult height, and allowed for lower average and cumulative daily HC dose compared to HC tablets in children with CAH. Reference: (1) Sarafoglou et al., J Clin Pharmacol.2015;55(4):452–7.
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