Final Height in Short Children Born Small for Gestational Age Treated with Growth Hormone

Abstract

The aim of this observational study was to assess the longterm growth responses to GH treatment of children born small for gestational age (SGA). GH treatment was begun before puberty and continued to final height (FH). Seventy-seven short (height SD score below Ϫ2) prepubertal children born SGA (below Ϫ2 SD for birth weight and/or birth length), with a broad range of GH secretory capacity, were treated with GH in a daily dose of 33 g/kg (0.1 U/kg), beginning before the onset of puberty. We observed a difference between adult and pretreatment projected height of 1.3 SD (9 cm) for the entire group. Among the children treated for Ͼ2 y before puberty, this mean gain (i.e. difference) in final height was 1.7 SD, whereas the mean gain was 0.9 SD among those in whom treatment was begun Ͻ2 y before puberty. Better catch-up growth was observed in the younger (r ϭ Ϫ0.56, p Ͻ 0.0001), shorter (r ϭ Ϫ0.49, p Ͻ 0.0001), and lighter (r ϭ Ϫ0.46, p Ͻ 0.0001) subjects. We conclude that GH treatment improves the final height of short children born SGA. The height gain attained before the onset of puberty is maintained to final height. The younger, shorter, and lighter the child at the start of GH treatment, the better the response. Moreover, most of these SGA individuals treated with GH reach their target height. There is a 5-to 7-fold higher risk of short stature among adults who were born SGA, compared with those born AGA (1,2). Children born SGA comprise one-third of children who are short during childhood (1). As short stature is present in 10 -15% of children born SGA (1-3), efforts have been made to understand the etiology of their growth restriction and to increase their FH.Birth length has been shown in population-based studies to be the single most important predictor of adult height (1,2). Short children born SGA keep their prepubertal height SDS to FH, whereas short children born AGA gain further 0.6 -0.7 SDS in height during puberty (4). French data show that adult men who were born SGA are, on average 7.5 cm, and women are 9.6 cm below their mid-parent target height (5). This is at the lower end of the range compared with other studies (1,6,7), which find a growth deficit of 0.7-0.9 SDS below the MPH.Either low GH secretion or reduced sensitivity to GH may account for some of the growth retardation of children born SGA (8 -10). Boguszewski et al. (11,12) reported that short children born SGA have both lower mean GH secretion rates and lower serum IGF-I (IGF-I) values than children born AGA. In children born SGA, there is a correlation between the GH dose and the growth response, mainly during prepubertal years (13-16). The majority of short children born SGA show improvement in growth rate during GH treatment, particularly if treatment is begun early (14,16). With the exception of one large study (17), however, no information is available on the FH achieved by short children born SGA and treated with GH from a young age to FH. We report here the observational data on the effect of GH therapy on final height of childr...

11β–Hydroxysteroid Dehydrogenase Type 1 Activity in Short Small-For-GA Children and in Response to GH Therapy

“…Some of these children do not catch up (1,2) and remain short. They may benefit from GH therapy (3)(4)(5). This subgroup is designated in this article as short SGA (SSGA).…”

MANAGEMENT OF ENDOCRINE DISEASE: Growth and growth hormone therapy in short children born preterm

“…Studies on the effects of GH for treatment of short stature of different etiologies usually included children born prematurely, especially those involving children born SGA (101,102). GH treatment was approved by the US Food and Drugs Administration in 2001 for children born SGA who fail to manifest catch-up growth by the age of 2 years.…”

GH-IGF-IGFBP Axis and Metabolic Profile in Short Children Born Small for Gestational Age

“…Several studies have demonstrated that growth hormone treatment effectively induces catch-up growth in prepubertal short SGA children (Dahlgren & Wikland, 2005;de Zegher et al, 2006;Sas et al, 1999). Adult height data from a Dutch multicenter study demonstrated that 85% of children reached a height above -2 SDS and 98% reached a height within the target height range (Van Pareren et al, 2003) (Figure 4).…”