Short Stature Associated with Intrauterine Growth Retardation: Final Height of Untreated and Growth Hormone-Treated Children

Abstract

Short term studies have demonstrated the acceleration of growth velocity after the administration of GH in short children born with intrauterine growth retardation (IUGR). We report the final heights of 70 IUGR children whose short stature was attributed to idiopathic GH deficiency (peak plasma GH <10 ng/mL at 2 provocative tests) and treated with GH at a mean dosage of 0.4 +/- 0.1 U/kg x week during an average of 4.6 +/- 2.5 yr. They were compared to a control group of 40 untreated short children born with IUGR, without GH deficiency. At the time of evaluation, age, auxological data, and pubertal status were similar in the 2 groups (height, -2.9 +/- 0.8 and -2.8 +/- 0.7 SD score). Final heights were comparable in both groups of children (-2 +/- 0.7 and -2.2 +/- 1.1 SD score). A multivariate analysis identified 4 independent predictors of final height, namely target height, age and body mass index at evaluation, and GH treatment. Treatment was associated with a gain of 0.6 SD score, suggesting a final height gain of about 3.4 cm. Fifty-three of 70 treated children were reevaluated after completion of growth, and 43 of 53 had a peak plasma GH level of 10 ng/mL or more. Auxological characteristics of these 53 patients were not different from those of nonreevaluated patients. We believe that the transient character of the GH deficiency in most patients and the nonstringent initial criteria used for the diagnosis of GH deficiency render the spontaneous growth potentials identical in the 2 groups of patients. Our data, therefore, suggest that GH treatment at this dosage has a limited effect on the final height of short children born with IUGR.

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

“…Nevertheless, nearly 90% of the GH-treated children achieved an FH within 1 SD of the target height, whereas only 50% of the untreated children achieved this-a finding in agreement with our populationbased study of untreated short children born SGA (1). Most of the reports on results of GH treatment on FH of short children born SGA are nonrandomized studies composed of small numbers of participants (30,31), or include only GHD children (17), many of whom entered puberty during the first year of treatment (17,30,31). Among children treated at a later age, a gain at near FH of 1 SD has been observed (30), a value comparable to the 0.9 SD for our subgroup of children treated for Ͻ2 y before puberty.…”

“…This is in accordance with our finding of a lack of further gain in height SDS during puberty, and agrees with the observation that skeletal maturation during puberty is relatively rapid (17). The rapid bone maturation that often occurs between 8 and 11 y of age among children born SGA may be the result of intrauterine programming of early puberty, rather than an effect of GH treatment.…”

“…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 children born SGA.…”

Final height of short subjects of low birth weight with and without growth hormone treatment

“…The analysis of our untreated group confirms6 15 16 that short subjects with low birth size, will not only remain well below their target height, but also do not reach their prediction, with final height close to height for CA at diagnosis. It was in fact the latter parameter, rather than height for BA at diagnosis, which had the strongest influence both on final height and on the gap between target height and final height (the greater the height for CA SDS at evaluation, the lower the gap).…”

“…This evidence is from short term studies, in which, despite promising initial growth acceleration, excessive maturation of bone age (BA) led to a fall in height prediction 45 Few studies have provided final height 67 Furthermore, it is not clear whether the traditional diagnostic tests to define GH secretion, often described as unreliable in choosing which short subjects are most likely to be treated successfully,8 are of use in low birth weight, short children.…”