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Birth weight affects final height in patients treated for growth hormone deficiency
E Cacciari1, S Zucchini, A Cicognani
1First Paediatric Clinic, University of Bologna, Bologna, Italy. ped1@alma.unibo.it
Insights
Birth weight significantly impacts final height in children treated for growth hormone (GH) deficiency. Those born small for gestational age (GA) achieved lower final heights compared to appropriate or large for GA individuals.
Area of Science:
- Pediatric Endocrinology
- Growth and Development
Background:
- Birth weight is a known factor influencing postnatal growth and initial response to growth hormone (GH) therapy in GH-deficient individuals.
- However, the precise relationship between birth weight and final height outcomes in these patients remains unclear.
Purpose of the Study:
- To investigate the association between birth weight status (small, appropriate, or large for gestational age) and final height achieved after GH therapy in children with GH deficiency.
Main Methods:
- A retrospective study analyzed 108 patients with idiopathic and isolated GH deficiency treated with human GH (hGH).
- Patients were categorized based on birth weight for gestational age: small (n=24), appropriate (n=77), and large (n=7).
- Final height was assessed after 33-96 months of hGH treatment at a dose of 20 U/m2/week.
Main Results:
- Patients born small for gestational age (GA) achieved significantly lower final height standard deviation scores (SDS) compared to appropriate and large for GA groups (-1.71 vs. -1.14 and -0.70 SDS, respectively).
- The height SDS increment from therapy initiation to final height was also significantly lower in the small for GA group (0.54) compared to the appropriate (0.99) and large (1.49) for GA groups.
- A higher percentage of large for GA individuals reached above their target height (71%) compared to appropriate (38%) and small for GA (21%) groups. A positive correlation was observed between birth weight and final height (r=0.38).
Conclusions:
- Birth weight is a significant determinant of final height outcomes in children with GH deficiency, even when treated with GH therapy.
- Individuals born small for GA experience a disadvantage in achieving final height, while those born large for GA appear to benefit.
- These findings underscore the importance of considering birth weight status when predicting and managing growth outcomes in GH-deficient children.
Objective:
Birth weight influences both postnatal growth and the initial response to GH therapy in GH-deficient subjects, but its relationship to final height is uncertain. Therefore, we examined final height results in a group of subjects treated for GH deficiency who were born small, appropriate or large for gestational age (GA).
Design:
Retrospective study.
Patients:
108 GH-treated patients (age at diagnosis 11.1 +/- 2.0 years) affected by idiopathic and isolated GH deficiency (peak < 8 microg/l after pharmacological and/or nocturnal mean GH concentration
Measurements:
All subjects reached final height (growth velocity < 0.5 cm/year in the last year of treatment) after hGH treatment (range 33-96 months) at a dose of 20 U/m2/week. The 3 groups of subjects started therapy at a similar height for chronological and bone age.
Results:
Final height in the small for GA group was - 1.71 +/- 0.93 standard deviation score (SDS), significantly lower than that of both appropriate (- 1.14 +/- 0.83 (P < 0.01)) and large (- 0.70 +/- 0.89 (P < 0.01)) for GA groups. Similarly, the small for GA group had a significantly lower height SDS increment from the start of therapy to adult height (0.54 +/- 0.84) than both the appropriate (0.99 +/- 0.78 (P < 0.05)) and the large (1.49 +/- 0.84 (P < 0.01)) for GA groups. The percentage of subjects with final height above target height was significantly different in the 3 groups: 21% for the small, 38% for the appropriate and 71% for the large for GA groups (P < 0.05). In the whole group of patients there was a positive correlation between birth weight and final height (r = 0.38; P < 0.0001).
Conclusions:
The present study showed that our patients, affected by isolated and idiopathic GH deficiency but with different birth weights, despite starting treatment with a similar height and bone age delay, had different auxological outcomes. It seems, therefore, that final height is strongly influenced by birth weight which penalizes the smaller newborns and assists the larger ones.