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High-dose growth hormone treatment of short children born small for gestational age
F de Zegher1, M Maes, S E Gargosky
1Belgian Study Group for Pediatric Endocrinology, Department of Pediatrics, University of Leuven, Belgium.
Insights
Growth hormone (GH) treatment significantly improved catch-up growth in short children born small for gestational age. This therapy enhanced height, weight, and growth velocity over two years.
Area of Science:
- Pediatric Endocrinology
- Growth and Development
Background:
- Children born small for gestational age (SGA) often experience persistent short stature.
- Catch-up growth is crucial for achieving appropriate adult height in these children.
Purpose of the Study:
- To evaluate the efficacy of daily subcutaneous growth hormone (GH) administration over two years in prepubertal children born SGA.
- To assess the impact of GH on growth velocity, height, weight, and bone maturation.
Main Methods:
- A randomized study involving 50 short, prepubertal children born SGA, allocated to receive no treatment or daily GH (0.2 or 0.3 IU/kg).
- Measurements included age, bone age, height, height velocity, weight, and body mass index (BMI) at baseline and over two years.
Main Results:
- All treated children achieved catch-up growth, with a near doubling of growth velocity and weight gain.
- GH treatment resulted in a mean height increase of over 2 standard deviation scores (SDS) and accelerated bone maturation.
- Biochemical markers such as insulin, IGF-I, IGFBP-3, and osteocalcin increased, while IGF-II remained unchanged.
Conclusions:
- High-dose GH administration over two years is a promising therapy for short stature in young children born SGA.
- GH treatment effectively promotes catch-up growth and improves height outcomes.
- Further research is needed to determine the long-term effects of this GH therapy.
Abstract:
The effect of GH administration was evaluated over 2 yr in 50 short, prepubertal, non-GH deficient children born small for gestational age, who had been randomly allocated to a group receiving no treatment or daily sc GH treatment at a dose of 0.2 or 0.3 IU/kg. At the start of the study, mean age was 5.2 yr, bone age was 4.0 yr, height SDS was -3.5, height velocity SDS was -0.8, weight SDS was -2.7, and body mass index SDS was -1.9. Catch-up growth was observed in none of the untreated and all of the treated children. The response to GH treatment included a near doubling of growth velocity and of weight gain and a mean height increment of more than 2 SDS. GH treatment was associated with a distinct acceleration of bone maturation. The differences between the growth responses evoked by the two GH doses were minor. The prepubertal GH-induced catch-up growth was associated with elevated serum concentrations of insulin, insulin-like growth factor-I, insulin-like growth factor binding protein-3, and osteocalcin, whereas insulin-like growth factor-II levels remained unaltered. GH treatment was well tolerated. In conclusion, high-dose GH administration over 2 yr is emerging as a potential therapy to increase the short stature that results from insufficient catch-up growth in young children born small for gestational age. The long-term impact of this approach remains to be delineated.