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Growth of prepubertal children with inflammatory bowel disease
M T Saha1, T Ruuska, P Laippala
1Department of Pediatrics, Tampere University Medical School, Finland.
Insights
Children with inflammatory bowel disease experience growth retardation, but treatment improves height velocity and normalizes height for age. Crohn's disease showed poorer growth outcomes compared to mild ulcerative colitis.
Area of Science:
- Pediatrics
- Gastroenterology
- Endocrinology
Background:
- Growth retardation is a known complication in pediatric inflammatory bowel disease (IBD), particularly Crohn's disease.
- Previous studies primarily focused on adolescent populations, leaving a gap in understanding prepubertal growth patterns.
Purpose of the Study:
- To investigate growth patterns in prepubertal children diagnosed with inflammatory bowel disease.
- To assess the impact of treatment on height and height velocity in this cohort.
Main Methods:
- Studied 47 prepubertal children (20 boys, 27 girls) with IBD.
- Calculated mean height and height velocity standard deviation scores at diagnosis and annually.
- Analyzed cumulative prednisone doses, disease severity, and used repeated measures ANOVA for statistical analysis.
Main Results:
- Children with IBD exhibited slower growth preceding diagnosis and were shorter than peers at diagnosis.
- Treatment led to increased mean height velocity (from -0.84 to +1.08 SDS) and normalized mean height (from -0.32 to +0.05 SDS).
- Severe Crohn's disease was associated with the poorest growth, while mild ulcerative colitis showed the best growth; prednisone treatment showed no significant difference.
Conclusions:
- Growth retardation is a significant indicator of IBD in both prepubertal and adolescent children.
- Therapeutic interventions effectively improve growth velocity, leading to normalized height-for-age in IBD patients as a group.
Background:
Growth retardation has been reported in children with chronic inflammatory bowel disease, especially in those with Crohn's disease. Most of these studies concern adolescent patients.
Methods:
The growth of 47 prepubertal children (20 boys and 27 girls, mean age at diagnosis 7 years) with inflammatory bowel disease was studied at Tampere University Hospital, Department of Paediatrics. The mean height and height velocity standard deviation scores were calculated at diagnosis and, after that, yearly. The cumulative doses of oral and rectal prednisone per year were calculated. The severity of the disease was scored. The statistical analysis was carried out using the analysis of variance for repeated measurements.
Results:
During the year preceding the diagnosis, children with inflammatory bowel disease had grown more slowly than their healthy peers. At diagnosis, they were slightly shorter as a group than are healthy children. During treatment and follow-up the mean height velocity of children with inflammatory bowel disease increased (change in the mean height velocity standard deviation scores from -0.84 to +1.08), normalizing the mean heights of these children compared with those of their healthy peers (change in the mean height standard deviation scores from -0.32 to +0.05). In the analysis of covariance, the poorest growth was seen in children with Crohn's disease, scored as severe, and the best growth in children with mild ulcerative colitis. No difference was seen in groups with or without prednisone treatment.
Conclusions:
Growth retardation is an important sign of chronic inflammatory bowel disease in prepubertal as well as adolescent children. During treatment, increasing growth velocity brings these children as a group to normal heights for age and sex.