Short Children with Low Birth Weight Born either Small for Gestational Age or Average for Gestational Age Show Similar Growth Response and Changes in Insulin-Like Growth Factor-1 to Growth Hormone Treatment during the First Prepubertal Year

Abstract

Background/Aims: Growth hormone (GH) is an accepted treatment for short children born small for gestational age (SGA). The aim of this analysis was to compare the growth response to GH in children with low birth weight born SGA or appropriate for gestational age (AGA). Methods: This retrospective observational study is from one center. Of all the children with a birth weight <2,500 g treated, 50 were primarily diagnosed as having growth hormone deficiency ([A] SGA, n = 26; [B] AGA, n = 24) and 138 were originally diagnosed SGA or AGA (reclassified: [C] SGA, n = 102; [D] AGA, n = 36). Results: [Median; A, B, C, D]: at an age of 4.9, 5.2, 5.8, 5.8 years, a height of –2.9, –2.4, –2.8, –2.9 SDS and a GH dose of 27, 28, 41, 39 µg/kg/day, the children grew 0.9, 0.9, 0.8, 0.9 SDS in height, respectively. Insulin-like growth factor-1 (IGF-1) at GH start was, respectively, –2.1, –2.2, –0.4, –0.9 SDS and rose to (delta IGF-1) 1.8, 2.0, 1.7, 1.5 SDS during the first year on GH. All differences were not significant. Conclusions: We show for the first time that short stature children with low birth weight born AGA experience the same increase in height and IGFs to GH treatment as those born SGA irrespective of actual GH secretory status.

Height, Muscle, Fat and Bone Response to Growth Hormone in Short Children with Very Low Birth Weight Born Appropriate for Gestational Age and Small for Gestational Age

“…The indicators of GH sensitivity IGF-1 and IGFBP-3 were measured throughout this study; they were low at the start of treatment and showed a similar increase in both groups (table 3), as expected from our previous studies [21]. …”

“…Our data show no significant differences between AGA and SGA children in their auxological parameters at the start of GH treatment. This has already been described in recent studies [1,2,3,6,21]. …”

Growth and the Growth Hormone-Insulin Like Growth Factor 1 Axis in Children With Chronic Inflammation: Current Evidence, Gaps in Knowledge, and Future Directions

“…The availability of recombinant human growth hormone (hGH) (rhGH) in the past 30 years has led to its use in nongrowth hormone deficient conditions (29) such as Turner Syndrome (30 -32), small for gestational age (SGA) (33,34), idiopathic short stature (35), short stature homeobox (SHOX) deficiency (36), Prader Willi Syn-drome (37) and chronic renal insufficiency (38). In younger prepubertal children with chronic disease and in those with pubertal delay who continue to grow slowly despite pubertal induction, rhGH may be a therapeutic option.…”

Constitutional Delay Influences the Auxological Response to Growth Hormone Treatment in Children with Short Stature and Growth Hormone Sufficiency

“…Further, current definitions of ISS exclude children who were born small for gestational age, although it is a separate indication for GH treatment in many countries2. There is conflicting evidence for whether children who are small for gestational age respond similarly to children who were appropriate for gestational age at birth1718. The New Zealand GH treatment programme was started well before this consensus, and so birth weight were not part of the entry criteria for ISS in New Zealand and so are not available for most children.…”