Growth Hormone Treatment Strategy for Short Children Born Small for Gestational Age

Czernichow, P

doi:10.1159/000080515

Cited by 8 publications

(7 citation statements)

References 35 publications

(23 reference statements)

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“…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]. In a long-term follow-up study of GH therapy in short children born SGA, increased IGF-1 levels were completely reversed after discontinuing GH [60].…”

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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Section: Discussionmentioning

confidence: 99%

Latin American Consensus: Children Born Small for Gestational Age

et al. 2011

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“…In July 2001, the Food and Drug Administration approved rhGH at a dose of 66 g/kg/day (or ϳ 0.2 IU/kg/ day based on a conversion factor of 1 mg = 3 IU) for longterm therapy of growth failure in children born SGA (less than -2 SDS) who fail to demonstrate catch-up growth by 2 years of age [40] . In Europe, the European Medicines Agency has approved rhGH at a dose of 35 g/kg/day ( ϳ 0.1 IU/kg/day) for the treatment of growth disturbances (current height SDS less than -2.5 and parental adjusted height SDS less than -1) in short children born SGA with a birth weight and/or length below -2 SD who failed to show catch-up growth (HV SDS !…”

Section: Treatment Objectivesmentioning

confidence: 99%

Growth Hormone Therapy for Short Children Born Small for Gestational Age

Chatelain

Carrascosa²,

Bona³

et al. 2007

Horm Res Paediatr

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Children born small for gestational age may demonstrate continued growth retardation, resulting in persistent short stature. In the majority of the cases, this is linked with abnormal growth hormone secretion and also abnormal insulin-like growth factor levels. This review discusses the treatment of such children with recombinant human growth hormone. It illustrates the importance of starting therapy early, the dose-dependent response, and the advantages of continuous therapy and describes safety considerations.

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“…These children, who account for approximately 10% of all SGA children, remain short (below –2 standard deviation scores (SDS)) throughout childhood and adulthood if left untreated [1,2,3]. In this population, GH treatment increases growth velocity and normalises adult height, and appears to be safe and well tolerated [3,4,5,6,7,8,9,10,11]. …”

Section: Introductionmentioning

confidence: 99%

Metabolic Impact of Growth Hormone Treatment in Short Children Born Small for Gestational Age

Lebl

Lebenthal²,

Koloušková³

et al. 2011

Horm Res Paediatr

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Background: Growth hormone (GH) treatment in short children born small for gestational age (SGA) may result in metabolic changes with potential long-term effects. Methods: 149 short SGA children (mean birth weight 2.0 ± 0.6 kg, age 5.5 ± 1.5 years, height standard deviation score (SDS) –3.1 ± 0.6) were randomised to: low-dose GH therapy (0.033 mg/kg/day) for 2 years; high-dose GH therapy (0.100 mg/kg/day) for 1 year, or mid-dose GH therapy (0.067 mg/kg/day) for 1 year. Leptin, ghrelin, insulin-like growth factor-I (IGF-I), IGF binding protein-1 (IGFBP-1), lipids, fasting blood glucose and fasting insulin were assessed at baseline, 12 and 24 months. Results: After 1 year of active treatment, GH significantly reduced serum ghrelin and increased IGF-I SDS and insulin levels. Regression analysis showed an inverse correlation between ghrelin and IGF-I SDS (p < 0.001). Leptin and IGFBP-1 also declined (both p < 0.05). Changes in insulin levels reversed upon discontinuation. Improvements in lipid profile were nonsignificant and fasting blood glucose levels remained within the normal range. Conclusion: In short SGA children, ghrelin and leptin reductions associated with GH treatment may occur through a negative feedback loop of the GH–IGF-I axis. Consequently, via ghrelin and leptin suppression, GH treatment may modify food intake and body composition and potentially improve long-term metabolic outcomes.

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Growth Hormone Treatment Strategy for Short Children Born Small for Gestational Age

Cited by 8 publications

References 35 publications

Latin American Consensus: Children Born Small for Gestational Age

Latin American Consensus: Children Born Small for Gestational Age

Growth Hormone Therapy for Short Children Born Small for Gestational Age

Metabolic Impact of Growth Hormone Treatment in Short Children Born Small for Gestational Age

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