First Two Years’ Response to Growth Hormone Treatment in Very Young Preterm Small for Gestational Age Children

Abstract

Background: Growth hormone (GH) is a therapeutic option for small for gestational age (SGA) children without spontaneous catch-up. There are few reports on preterm SGA children. Prematurity is an additional risk factor for adult short stature. Aim: To describe GH efficacy in preterm SGA patients. Methods: Twenty-five preterm SGA patients, 2–4 years old, treated with GH 0.066 mg/kg/day, were compared with 14 age-matched preterm SGA historical controls. Height, weight, IGF-I, IGFBP-3, fasting glucose and insulin were measured every 6 months. Results: At start of GH treatment, mean height and weight were –2.4 and –2.4 SDS, respectively. There was a significant increment in height SDS of 1.3 and 2.1 during the 1st and the 2nd year of GH therapy, respectively. There was no significant difference between the progression of chronological and bone ages. A significant increase in IGF-I, IGFBP-3 and molar ratio was observed during GH therapy. There was no difference in glucose, insulin or HOMA-IR index. Conclusion: We showed for the first time that the height increment of preterm SGA with GH treatment is similar to that described in other studies with term SGA patients. Therefore, short-term GH treatment in a subset of preterm SGA patients between 2–4 years of age was able to promote adequate growth recovery with no excessive bone age acceleration or adverse effects on carbohydrate metabolism.

Short Children with Low Birth Weight Born either Small for Gestational Age or Average for Gestational Age Show Similar Growth Response and Changes in Insulin-Like Growth Factor-1 to Growth Hormone Treatment during the First Prepubertal Year

“…The same pattern was observed in our children with GHD and low birth weight irrespective of relative size at birth. The children on supra-physiological GH doses as they are used in SGA showed levels of both IGF-1 and IGFBP-3 in the upper normal range or even elevated levels similar to other studies [6,31,35,36]. There was, however, no difference between children born SGA or AGA during the two pre-pubertal years of observation.…”

“…In general, GH levels tend to be normal, while IGF-1 levels are reduced, but are higher than observed in GHD, and IGFBP-3 levels are normal for age. Such a pattern of IGFs was also observed in short preterm SGA children [31]. The present study was not designed to give exact information about the GH secretory status of children primarily classified SGA.…”

“…The responses of the children with low birth weight and GHD or short stature born SGA in terms of height velocity (cm/year) or change in height SDS during the first prepubertal year were in the same order of magnitude as reported in other series [29,30], although most of the children with GHD in these studies had a normal size at birth and children born SGA were not born severely preterm. In a cohort of short preterm SGA children who were younger (median: 2.7 years) and received a higher GH dose (66 mg/kg day), slightly higher growth rates were observed [31]. In the study by de Kort et al [32], there was no difference in growth response between SGA children born before and after 36 weeks of gestation.…”

Growth hormone regimens in Australia: analysis of the first 3 years of treatment for idiopathic growth hormone deficiency and idiopathic short stature

“…The most notable differences are the extensive use of auxological assessment, dosing in mg/ m 2 rather than in mg/kg, a low, by international comparison, GH starting dose of 4AE5 mg/m 2 /week, [1][2][3][4][5][6][7] and the provision to increment the dose at six monthly intervals. 8 Patients are assessed relative to set eligibility criteria for a number of specified indications.…”

Three-Year Growth Response to Growth Hormone Treatment in Very Young Children Born Small for Gestational Age—Data from KIGS

“…With a careful monitoring of postnatal growth, especially during the first months of life, we believed that it is possible to identify the subgroup of SGA children who will not catch-up spontaneously and start GH treatment as early as by 2 years of age. Preterm SGA children have also been treated with positive results (19,20). In our study, half of the 156 children in the 2-4 yrs group and 42% in the 4 -6 yrs group were born with gestational age Յ 37 weeks, reflecting the increasing incidence of prematurity during the last decades (21).…”