Factors influencing growth hormone therapy effect during the prepubertal period in small for gestational age children without catch-up growth

Abstract

Purpose Because small for gestational age (SGA) children who fail to experience catch-up growth have an increased risk of short stature in adulthood, growth hormone (GH) treatment is recommended for effective growth. In this study, we evaluated the effect of GH treatment during the prepubertal period and analyzed for correlation between GH treatment response and clinical factors in SGA children. Methods A retrospective, single-center study was conducted from 2014 to 2020. A total of 34 prepubertal children of short stature up to 4 years of age and born as SGA were enrolled. We recorded clinical data including birth data, age, weight, height, bone age (BA), and insulin-like growth factor 1 (IGF-1) levels. Results The mean gestational age and birth weight were 37.50±2.51 weeks and 2,200.00±546.79 g. At the start of GH treatment, the mean chronological age and BA were 5.54±1.73 years and 4.52±1.85 years, respectively. The height standard deviation score (SDS) (-2.47±0.45) and IGF-1 SDS (0.16±1.57) were calculated. Height velocity was 9.43±1.40 cm during the first GH treatment year and 7.63±1.16 cm during the second year ( P <0.05). The treatment growth response was positively correlated with young age ( P =0.047) and lower BA ( P =0.049) at the start of treatment. In multiple regression analysis, IGF-1 SDS change had a significantly positive association with GH treatment response ( P =0.045). Conclusions GH treatment is effective for short stature SGA children who do not experience catch-up growth. Early initiation of GH treatment improved growth outcomes. As IGF-1 SDS is positively correlated with height SDS, IGF-1 monitoring is important during GH treatment of SGA prepubertal children.

Tratamiento con hormona de crecimiento en niños nacidos pequeños para la edad gestacional. Experiencia de un centro

“…La edad de derivación (3,87 años) era menor en nuestra muestra que en estudios publicados previos (5,54 a 8,1 años), sin embargo, cabe destacar que la edad media previa a 2017 era de 7,36 años (mediana 6,13 años y 3,35 DE) y descendió a 3,87 años en los últimos 4 años. [7][8][9][10] Esto se debió en parte a sesiones que se realizaron en los servicios de Pediatría, Neonatología y Atención Primaria para potenciar la derivación precoz de estos casos. Se produjo un descenso considerable de la edad de derivación tras dichas charlas, lo que apoya la realización de estas medidas para conseguir un mejor pronóstico de los casos que precisen tratamiento, ya que se ha relacionado la edad menor con una mejor talla final.…”

“…Se produjo un descenso considerable de la edad de derivación tras dichas charlas, lo que apoya la realización de estas medidas para conseguir un mejor pronóstico de los casos que precisen tratamiento, ya que se ha relacionado la edad menor con una mejor talla final. 7 En cuanto a la edad gestacional, hay estudios que apoyan que, cuanto menor sea esta, más riesgo habrá de no alcanzar el crecimiento compensatorio (catch-up) y precisar tratamiento, lo que también justificaría nuestra media (35,95 semanas). 3,11 Se destaca el predominio femenino de nuestra muestra en los pacientes tratados, aunque había un predominio masculino en la muestra total de PEG.…”

Integrated Digital Health Solutions in the Management of Growth Disorders in Pediatric Patients Receiving Growth Hormone Therapy: A Retrospective Analysis

“…For all indications, optimal response requires early GH initiation and continuous treatment for several years through adolescence ( 11 , 15 , 28 ). Response is highest in the first year of therapy, declining over subsequent years ( 15 , 16 , 29 ).…”

Long-term effectiveness of growth hormone therapy in children born small for gestational age: An analysis of LG growth study data

“…Growth hormone treatment has become much more frequent for SGA children with short stature after the approval of medical insurance in Korea. Although many studies have found that GH treatment is an effective treatment for individuals with SGA who do not experience catch-up growth, there has been no large cohort study of the effectiveness of GH in Korean children born SGA [ 8 , 9 ].…”