Does growth hormone treatment improve final height attainment of children with intrauterine growth retardation?

Abstract

Twenty four children (five girls, 19 boys) who had intrauterine growth retardation were treated with daily subcutaneous biosynthetic human growth hormone, initially in a dose of either 15 or 30 U/m2/week for the first year and in the latter dose for the next two years. Six patients (one girl, five boys) had no dysmorphic signs and 18 (four girls, 14 boys) had signs of Russeli-Silver syndrome. AU had birth weights below the third centile when adjusted for gestation age and ali the children were below the third height centile at the start oftreatment.Mean age was 6*3 years (range 2-1-9-7) when growth hormone treatment was started. All had normal growth hormone secretion to either a pharmacological or physiological test.In the first year of treatment, height velocity SD score increased from -0.75 to +3-6 in the group treated with 30 U/m2/week, and from -0-77 to +1-4 in the lower dose group. After three years of treatment, mean height velocity SD score was +1*1, irrespective of which initial treatment dose had been administered during the first year. There was no difference in the growth response of children with or without dysmorphic features. However, despite the sustained increase in growth rate, there was no significant change in height for bone age SD score, pointing to an unaltered final height outcome.

The Somatotropic Axis in Short Children Born Small for Gestational Age: Relation to Insulin Resistance

“…It has been suggested that short SGA children may have a degree of IGF-I resistance as higher basal and GH-induced IGF-I levels are required to achieve a growth velocity similar to that of other children (40). Relative IGF-I resistance at the pituitary could contribute to the elevated GH secretion seen in our short SGA children, and would also be compatible with the observation that supra-physiologic GH doses are required to significantly improve final height prognosis in short SGA children (41)(42)(43). Thus, short SGA children may appear to have a shift in the set point of their GH/IGF-I axis.…”

Growth Hormone Treatment of Short Children Born Small for Gestational Age

“…More recently, daily subcutaneous placebo injections have been documented to exert no consistent growth-promoting effect over 6 months in this group of short children (9). In contrast, high-dose GH schedules were found to result in a pronounced acceleration of statural growth, but the conclusions to be drawn from these observations were limited in part by the lack of fully parallel controls (9,10).…”

Growth Hormone Treatment in Children with Short Stature Born Small for Gestational Age: 5-Year Results of a Randomized, Double-Blind, Dose-Response Trial

“…Initial data were disappointing, probably due to the low dose and frequency of GH administration. Recent short term studies have shown that daily administration of recombinant human GH therapy in varying dosages accelerates growth significantly in short children born SGA (7,(15)(16)(17)(18)(19)(20)(21)(22).…”