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Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis
K A Bonuck1, K Freeman, J Henderson
1Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Mazer, Bronx, NY 10461, USA. bonuck@montefiore.org
Insights
Adenotonsillectomy significantly improves growth and growth biomarkers in children with sleep disordered breathing (SDB). This suggests SDB should be considered in cases of childhood growth failure.
Area of Science:
- Pediatric Endocrinology
- Sleep Medicine
- Surgical Outcomes
Background:
- Sleep disordered breathing (SDB) in children, often caused by enlarged adenoids and tonsils, is linked to impaired growth.
- Growth failure in children can be exacerbated by SDB, necessitating investigation into effective treatments.
Purpose of the Study:
- To evaluate the impact of adenoidectomy and/or tonsillectomy (adenotonsillectomy) on growth and key growth biomarkers in children with SDB.
- To determine if surgical intervention for SDB improves anthropometric measurements and serum levels of IGF-1 and IGFBP-3.
Main Methods:
- A systematic review and meta-analysis of observational studies published between January 1980 and November 2007.
- Searched PubMed, ERIC, and Cochrane Reviews for studies reporting pre/post-adenotonsillectomy changes in height, weight, IGF-1, and IGFBP-3 in children.
- Included studies with available z scores or centiles for anthropometrics and serum levels.
Main Results:
- Meta-analysis of 20 studies involving 363-390 children showed significant post-adenotonsillectomy increases.
- Pooled standardized mean differences (SMD) indicated improvements in standardized height (SMD=0.34) and weight (SMD=0.57).
- Significant increases were also observed in IGF-1 (SMD=0.53) and IGFBP-3 (SMD=0.59) levels.
Conclusions:
- Adenotonsillectomy leads to significant improvements in standardized height, weight, and growth biomarkers (IGF-1, IGFBP-3).
- Healthcare providers should consider SDB due to adenotonsillar hypertrophy in the evaluation and management of children experiencing growth failure.
Objective:
To determine the effect of adenoidectomy and/or tonsillectomy ("adenotonsillectomy") upon growth and growth biomarkers, in the context of sleep disordered breathing (SDB). SDB in children, primarily due to adenotonsillar hypertrophy, increases the risk of growth failure.
Design:
Systematic review and meta-analysis. PubMed, ERIC and Cochrane Reviews databases from January 1980 to November 2007 were searched for studies reporting: pre/post-adenotonsillectomy height and weight changes as percentage increased or decreased, raw data, z scores or centiles, or: IGF-1 and/or IGFBP-3 serum-level changes as z scores or raw data. For anthropometrics, the meta-analysis included studies presenting z scores or centiles.
Setting:
Observational studies.
Patients:
Otherwise healthy children, not selected for obesity.
Main Outcome Measures:
Pre/post-surgery changes in standardised height and weight, and IGF-1 and IGFBP-3.
Results:
Of 211 citations identified, 20 met systematic review criteria. SDB was an enrolment criterion in 13 of the studies, and one of several enrolment criteria in three. Meta-analysis findings for pre/post-surgery changes were: standardised height: 10 studies, 363 total children, pooled standardised mean differences (SMD) = 0.34 (95% CI 0.20 to 0.47); standardised weight: 11 studies, 390 total children, pooled SMD = 0.57 (95% CI 0.44 to 0.70); IGF-1: 7 studies, 177 total children, pooled SMD = 0.53 (95% CI 0.33 to 0.73); IGFBP-3: 7 studies, 177 total children, pooled SMD = 0.59 (95% CI 0.34 to 0.83).
Conclusions:
Standardised height and weight, and IGF-1 and IGFBP-3 increased significantly after adenotonsillectomy. Findings suggest that primary care providers and specialists consider SDB secondary to adenotonsillar hypertrophy when screening, treating and referring children with growth failure.
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