Growth Hormone Therapy for Short Children Born Small for Gestational Age

Chatelain, Pierre; Carrascosa, Antonio; Bona, Gianni; Ferrández-Longás, Angel; Sippell, W.G.

doi:10.1159/000107935

Cited by 20 publications

(22 citation statements)

References 113 publications

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“…Results here also indicate that r-hGH therapy in children born SGA is well tolerated, supporting other reports that treatment-related AEs are rare in this patient population [20,21,22]. The treatment was well tolerated in both groups, with only 5 AEs reported by 3 children over year 4 of therapy.…”

Section: Discussionsupporting

confidence: 89%

Optimization of Growth Hormone Dosing in Children Born Small for Gestational Age: An Open-Label, Randomized Study of Children during the Fourth Year of Therapy

Chatelain

Colle²,

Nako³

et al. 2012

Horm Res Paediatr

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Background: Optimal dosage for growth hormone (GH) therapy in short, prepubertal children born small for gestational age (SGA) is controversial. Methods: SGA OPTIMIS (NCT00249821) is a multicenter, open-label, parallel-group, pilot study of short children born SGA who had received recombinant human GH (r-hGH) (57 µg/kg/day) for 3 years. Children were randomized 1:1 to receive either 57 or 35 µg/kg/day r-hGH during year 4. The primary endpoint was height gain during year 4. Results: 22 children were randomized (57 µg/kg/day, n = 10; 35 µg/kg/day, n = 12) and 21 completed the fourth year of therapy; 22 were included in efficacy analyses. During year 4, mean [standard deviation (SD)] height velocity was 6.4 (1.4) and 4.4 (1.2) cm/year (p = 0.001) and height velocity SD score (SDS) was 0.3 (0.3) and –0.1 (0.2) (p = 0.002) in the 57 and 35 µg/kg/day groups, respectively. The 57 µg/kg/day group continued with catch-up growth, had a significantly higher mean weight gain (p = 0.015) and significantly higher insulin-like growth factor-I levels at 12 months (p = 0.038). Five treatment-emergent adverse events were reported; none was serious or caused study withdrawal. Conclusions: Children who continued receiving 57 µg/kg/day r-hGH in year 4 had significantly greater height gain than those receiving 35 µg/kg/day r-hGH.

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Section: Discussionsupporting

confidence: 89%

Optimization of Growth Hormone Dosing in Children Born Small for Gestational Age: An Open-Label, Randomized Study of Children during the Fourth Year of Therapy

Chatelain

Colle²,

Nako³

et al. 2012

Horm Res Paediatr

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“…However, because of increased prevalence of metabolic disturbances and high blood pressure in adults born SGA [15,17,18,52-55], specific attention must be paid to glucose homeostasis and weight gain in short SGA children treated with GH. Previous studies have demonstrated that discontinuation of long-term GH treatment in SGA adolescents normalized insulin levels (both fasting and stimulated) after a significant increase during GH therapy [56,57]. …”

Section: Discussionmentioning

confidence: 99%

“…GH treatment does not appear to be associated with an increased risk of malignancy [57]. It is recommended that IGF-1 concentrations should be monitored and GH dose should be reduced in children with a plasma IGF-1 above +2 SD [58,59].…”

Section: Discussionmentioning

confidence: 99%

Latin American Consensus: Children Born Small for Gestational Age

et al. 2011

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BackgroundChildren born small for gestational age (SGA) experience higher rates of morbidity and mortality than those born appropriate for gestational age. In Latin America, identification and optimal management of children born SGA is a critical issue. Leading experts in pediatric endocrinology throughout Latin America established working groups in order to discuss key challenges regarding the evaluation and management of children born SGA and ultimately develop a consensus statement.DiscussionSGA is defined as a birth weight and/or birth length greater than 2 standard deviations (SD) below the population reference mean for gestational age. SGA refers to body size and implies length-weight reference data in a geographical population whose ethnicity is known and specific to this group. Ideally, each country/region within Latin America should establish its own standards and make relevant updates. SGA children should be evaluated with standardized measures by trained personnel every 3 months during year 1 and every 6 months during year 2. Those without catch-up growth within the first 6 months of life need further evaluation, as do children whose weight is ≤ -2 SD at age 2 years. Growth hormone treatment can begin in SGA children > 2 years with short stature (< -2.0 SD) and a growth velocity < 25th percentile for their age, and should continue until final height (a growth velocity below 2 cm/year or a bone age of > 14 years for girls and > 16 years for boys) is reached. Blood glucose, thyroid function, HbA1c, and insulin-like growth factor-1 (IGF-1) should be monitored once a year. Monitoring insulin changes from baseline and surrogates of insulin sensitivity is essential. Reduced fetal growth followed by excessive postnatal catch-up in height, and particularly in weight, should be closely monitored. In both sexes, gonadal function should be monitored especially during puberty.SummaryChildren born SGA should be carefully followed by a multidisciplinary group that includes perinatologists, pediatricians, nutritionists, and pediatric endocrinologists since 10% to 15% will continue to have weight and height deficiency through development and may benefit from growth hormone treatment. Standards/guidelines should be developed on a country/region basis throughout Latin America.

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“…Several studies demonstrated that GH treatment in short children born SGA results in normalization of height during childhood and adulthood, while untreated children show no improvement in growth [3,[26][27][28][29][30][31]. During GH treatment in children born SGA, there is a rapid increase in total IGF-I levels and a slower increase in IGFBP-3 levels [32].…”

Section: Small For Gestational Agementioning

confidence: 99%