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Steroid Administration and Growth Impairment in Children with Crohn's Disease
Carl Frédéric Duchatellier1, Rituanjali Kumar, Alfreda Krupoves
1*Centre de Recherche CHU Sainte-Justine, Montréal, QC, Canada; †Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada; ‡Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland; and §Department of Pediatrics, University of Montréal, Montréal, QC, Canada.
Insights
Steroid use in children with Crohn's disease is not linked to permanent growth impairment. Most children experiencing temporary growth issues recover to normal adult heights.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Inflammatory Bowel Disease Research
Background:
- Growth impairment is a significant concern in pediatric Crohn's disease.
- The role of steroid therapy in growth impairment remains unclear.
- Investigating the impact of steroids on temporary and permanent growth impairment is crucial.
Purpose of the Study:
- To determine the frequency of temporary (TGI) and permanent (PGI) growth impairment in pediatric Crohn's disease patients receiving steroids.
- To examine the association between cumulative steroid administration and TGI/PGI.
Main Methods:
- Retrospective cohort study of pediatric Crohn's disease patients (<18 years) treated with steroids.
- Ascertained steroid dosage, height, adult height, and parental heights.
- Defined TGI (height z score <-1.64) and PGI (adult height <8.5 cm below target).
- Logistic regression analyzed steroid dosage association with TGI/PGI; compared with Swiss IBD Cohort Study data.
Main Results:
- 19% of children experienced TGI; 5.8% had PGI.
- TGI associated with younger age at diagnosis and steroid initiation, but not steroid dosage.
- Final adult height correlated with target height, independent of cumulative steroid dose.
- PGI rates were 9.1% in steroid users vs. 2.7% in non-users in the Swiss cohort.
Conclusions:
- The majority of children with temporary growth impairment achieve normal adult heights.
- Cumulative steroid use does not appear to be associated with temporary or permanent growth impairment in pediatric Crohn's disease.
Background:
Growth impairment remains a major concern in children with Crohn's disease, but evidence remains unclear, in particular, whether steroid use is implicated. We aimed to (1) determine the frequency of temporary (TGI) and permanent (PGI) growth impairment in children administered steroids and (2) examine whether cumulative steroid administration was associated with TGI and/or PGI.
Methods:
A retrospective cohort study was performed in patients with Crohn's disease (<18 yr) administered steroids at the gastroenterology clinics of Sainte-Justine Hospital, Montreal. Steroid dosage, height during follow-up, adult height (after age 20), and parental heights were ascertained. Patients with height z score <-1.64 on more than 1 occasion before age 18 were considered as patients with TGI. Patients with adult heights <8.5 cm below the expected target heights were considered as patients with PGI. Association between steroid dosage and TGI/PGI was studied using logistic regression analyses. Data from the Swiss IBD Cohort Study were analyzed for comparison.
Results:
A total of 221 children were studied. Approximately 19% (42/221) children were deemed as TGI, and 8/137 patients (5.8%) had PGI. TGI was associated with diagnosis at younger age (P value 0.002) and steroid administration at younger age (P value 0.001), but not with steroid dosage. Final adult height was associated with target height, but not with cumulative steroid dosage. Rates of PGI in the Swiss cohort were ∼ 9.1% in steroid users and 2.7% in nonusers.
Conclusions:
Most children with TGI attain normal adult heights. Cumulative steroid use does not seem to be associated with either TGI or PGI in children with Crohn's disease.
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