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[Intra-uterine growth retardation: an indication for treatment with growth hormone?]
1Afd. Kindergeneeskunde, Erasmus Universiteit en Academisch Ziekenhuis/Sophia Kinderziekenhuis, Rotterdam.
Insights
Most children with intra-uterine growth retardation (IUGR) achieve catch-up growth. Some with poor catch-up growth have insufficient growth hormone (GH) secretion, and GH-therapy shows short-term benefits for height velocity.
Area of Science:
- Pediatrics
- Endocrinology
- Child Growth and Development
Background:
- Intra-uterine growth retardation (IUGR) results in a heterogeneous group of children.
- Postnatal growth, growth hormone (GH) secretion, and GH-therapy are crucial for children with short stature post-IUGR, excluding chromosomal disorders or syndromes like Silver-Russell Syndrome (SRS).
Purpose of the Study:
- To analyze postnatal growth, GH secretion, and the efficacy of GH-therapy in children with short stature following IUGR.
- To investigate the relationship between catch-up growth, GH secretion, and response to GH-therapy in this cohort.
Main Methods:
- Retrospective analysis of postnatal growth data in children with IUGR.
- Assessment of GH secretion in children with poor catch-up growth.
- Evaluation of short-term outcomes of GH-therapy, including growth velocity and adverse events.
Main Results:
- 86% of IUGR children exhibited spontaneous catch-up growth within two years; 14% did not.
- 60-80% of non-catch-up children showed insufficient GH secretion, often without typical GH deficiency characteristics.
- GH-therapy increased growth velocity short-term, with heterogeneous individual responses and no serious adverse events observed.
Conclusions:
- GH-therapy offers short-term growth benefits for children with IUGR and short stature.
- Further long-term studies are required to determine if GH-therapy impacts final adult height and to identify predictive factors for treatment success.
Abstract:
Children with intra-uterine growth retardation (IUGR) constitute a heterogeneous group. Classification and etiology of IUGR are given. This report presents data on postnatal growth, growth hormone (GH) secretion and GH-therapy in children with short stature after IUGR, which was not based on a chromosomal disorder or a syndrome, with exception of Silver-Russell Syndrome (SRS). During the first two years of life, 86% of the children with IUGR showed spontaneous catch-up growth to a height above the third percentile, while only 14% did not. Sixty to eighty percent of the children with poor catch-up growth showed an insufficient GH-secretion, despite of the fact that most children did not show the typical, clinical characteristics of children with classical growth hormone deficiency. GH-therapy leads to increased growth velocity, but so far only short-term results have been reported. No serious adverse events were observed. The individual growth responses were heterogeneous, but no difference was shown in the response between the sexes or between those with or without SRS. It is still unclear whether GH-therapy will improve final height and which factors enable detection of patients who will most likely benefit from GH-therapy. Only long-term clinical trials until final height will answer those questions.