Important Tools for Use by Pediatric Endocrinologists in the Assessment of Short Stature

Abstract

Assessment and management of children with growth failure has improved greatly over recent years. However, there remains a strong potential for further improvements by using novel digital techniques. A panel of experts discussed developments in digitalization of a number of important tools used by pediatric endocrinologists at the third 360° European Meeting on Growth and Endocrine Disorders, funded by Merck KGaA, Germany, and this review is based on those discussions. It was reported that electronic monitoring and new algorithms have been devised that are providing more sensitive referral for short stature. In addition, computer programs have improved ways in which diagnoses are coded for use by various groups including healthcare providers and government health systems. Innovative cranial imaging techniques have been devised that are considered safer than using gadolinium contrast agents and are also more sensitive and accurate. Deep-learning neural networks are changing the way that bone age and bone health are assessed, which are more objective than standard methodologies. Models for prediction of growth response to growth hormone (GH) treatment are being improved by applying novel artificial intelligence methods that can identify non-linear and linear factors that relate to response, providing more accurate predictions. Determination and interpretation of insulin-like growth factor-1 (IGF-1) levels are becoming more standardized and consistent, for evaluation across different patient groups, and computer-learning models indicate that baseline IGF-1 standard deviation score is among the most important indicators of GH therapy response. While physicians involved in child growth and treatment of disorders resulting in growth failure need to be aware of, and keep abreast of, these latest developments, treatment decisions and management should continue to be based on clinical decisions. New digital technologies and advancements in the field should be aimed at improving clinical decisions, making greater standardization of assessment and facilitating patient-centered approaches.

Automated growth monitoring app (GROWIN): a mobile Health (mHealth) tool to improve the diagnosis and early management of growth and nutritional disorders in childhood

“…1 New digital technologies in the pediatric endocrinology setting allow efficient and precise assessment performance. 9 Height measurements outside the clinic could increase the frequency of these evaluations and provide signs of growth failure to support earlier intervention. 10 Moreover, in addition to early diagnosis, internet or telephone-based interventions have been reported to be effective in improving BMI and weight loss or increasing physical activity in obese adults.…”

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

“…As a result, it is imperative to closely monitor children throughout treatment. Within the clinic, several important diagnostic and management tools are available to assess the cause and track the therapy response including catch-up growth, genetic analyses, GH stimulation tests, serum insulin-like growth factor-1 (IGF-1) concentration, bone age, and brain magnetic resonance imaging ( 3 ).…”

“…Growth response to GH treatment depends on several factors such as age, age at start of therapy, sex, indication, and GH dose. Since the 1990s, data from large cohorts of GH-treated children have been used in several different algorithms devised to predict the growth response from such factors ( 3 , 29 ). Due to the requirement to input the necessary data, these prediction models have only been used to a limited extent.…”

“…At the same time, healthcare systems are facing a crossroads that is characterized by resource limitation and an increased demand for personalized patient care. Digitalization has changed these dynamics by improving patient access to information, facilitating monitoring, intervention, and communications with healthcare providers, and thus reducing traditional limitations associated with healthcare services (1)(2)(3)(4)(5). Indeed, digital health has played a key role in keeping systems operational during the COVID-19 pandemic, helping patients to access care in more convenient ways without the burden of regular office visits and the unnecessary risk of exposure to infection (6,7).…”

Accelerating digital health literacy for the treatment of growth disorders: The impact of a massive open online course

“…In this regard, digital health solutions can offer more personalized support to patients and may ameliorate the need for regular contact with healthcare professionals, without the need to travel to consultations. The management of growth disorders is a complex and multifaceted area where response to therapy drives the outcome which is supported by adherence ( 16 ).…”