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Growth hormone to improve short bowel syndrome intestinal autonomy: a pediatric randomized open-label clinical trial
Noel Peretti1, Irene Loras-Duclaux, Behrouz Kassai
1Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France. noel.peretti@chu-lyon.fr
Insights
Growth hormone (GH) did not help children with short bowel syndrome (SBS) reduce their reliance on parenteral nutrition (PN). This study found no significant difference in weaning off PN between children receiving GH and those who did not.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Nutrition Science
Background:
- Parenteral nutrition (PN) is a critical intervention for short bowel syndrome (SBS) in children.
- The efficacy of growth hormone (GH) in facilitating PN weaning in pediatric SBS remains uncertain.
- Limited randomized controlled trials exist for GH use in this population.
Purpose of the Study:
- To investigate the effect of growth hormone (GH) on weaning pediatric patients with short bowel syndrome (SBS) off long-term parenteral nutrition (PN).
- To assess whether GH administration can enhance the reduction of PN dependency in children with SBS.
Main Methods:
- A prospective, randomized, open-label, multicenter study involving 14 pediatric patients with SBS and long-term PN dependency.
- Patients received a standardized PN reduction protocol, with randomization to either a growth hormone (GH) group or a control (CTR) group.
- Nutritional intake and blood parameters were monitored, with comparisons made using the Wilcoxon test.
Main Results:
- Growth hormone (GH) treatment did not significantly improve the rate of weaning off parenteral nutrition (PN) in children with short bowel syndrome (SBS).
- Both the GH and control groups showed similar decreases in PN caloric intake.
- Parenteral needs reverted to near basal levels post-treatment, with no significant changes in weight or biological parameters observed.
Conclusions:
- Growth hormone (GH) is not effective in promoting the weaning off of parenteral nutrition (PN) for children suffering from short bowel syndrome (SBS).
- Further research may be needed to explore alternative strategies for PN weaning in this patient group.
Background:
The ability of growth hormone (GH) to promote the weaning-off of parenteral nutrition (PN) in short bowel syndrome (SBS) is unclear. No randomized controlled study is available in children. This study was undertaken to determine if GH could enhance the weaning off of PN in PN-dependent children with SBS.
Methods:
A prospective randomized open-label multicenter study was performed in 14 patients (mean age, 9 ± 1.4 years) with SBS (average small bowel length, 33 cm) and long-term PN dependency (8 years) on an unrestricted diet. A standardized PN decrease with and without GH (0.14 mg/kg/d) was conducted. The patients were randomized to either a GH group (4 months of GH) or a control (CTR) group (4 months without GH, followed by 4 months with GH). Blood tests and a nutrition assessment of enteral and parenteral intakes were performed. Groups were compared with the Wilcoxon test.
Results:
Treatment with GH did not improve the weaning off of PN (decrease in PN caloric intake of 32.5% ± 9.6% in the GH group vs 35.2% ± 8.7% in the CTR group, nonsignificant). In the CTR group, GH treatment induced an additional but not statistically significant decrease of 8.8% ± 12.4% in daily calories. Parenteral needs returned to near basal rates 6 months after GH discontinuation (GH: 77.6% ± 10.6% vs CTR: 73.2% ± 7.4%). Weight decreased slightly in both groups. No biological parameters varied significantly.
Conclusions:
GH did not improve the weaning off of PN in PN-dependent children with SBS.
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