Poor growth response during the first year of growth hormone treatment in short prepubertal children with growth hormone deficiency and born small for gestational age: a comparison of different criteria

Saartje Straetemans, Muriel Thomas, Margarita Craen, Raoul Rooman, Jean De Schepper, BESPEED, A France, H Dotremont, M Den Brinker, M Cools, K De Waele, S Van Aken, S van der Straaten, I Gies, J Vanbesien, J P Bourguignon, M C Lebrethon, A S Parent, C Heinrichs, S Tenoutasse, C Brachet, E Boros, M Maes, V Beauloye, P Lysy, G Massa, R Zeevaert, F de Zegher, I Francois, D Beckers, M Van Helvoirt, K Casteels, D Beckers, T Mouraux, K Logghe, G Thiry-Counson, O Chivu, S Depoorter, Saartje Straetemans, Muriel Thomas, Margarita Craen, Raoul Rooman, Jean De Schepper, BESPEED, A France, H Dotremont, M Den Brinker, M Cools, K De Waele, S Van Aken, S van der Straaten, I Gies, J Vanbesien, J P Bourguignon, M C Lebrethon, A S Parent, C Heinrichs, S Tenoutasse, C Brachet, E Boros, M Maes, V Beauloye, P Lysy, G Massa, R Zeevaert, F de Zegher, I Francois, D Beckers, M Van Helvoirt, K Casteels, D Beckers, T Mouraux, K Logghe, G Thiry-Counson, O Chivu, S Depoorter

Abstract

Background: There is no consensus on the definition of poor growth response after the first year of growth hormone (GH) treatment. We determined the proportion of poor responders identified by different criteria in children with GH deficiency (GHD) and born small for gestational age (SGA). The second aim was to analyze the IGF-1 response in poor growth responders.

Methods: First-year height data of 171 SGA and 122 GHD children who remained prepubertal during the first GH treatment year were retrieved from the BESPEED database and analyzed. Criteria for poor first-year response/responsiveness were: change in height (∆Ht) SDS<0.3 or<0.5, height velocity (HV) SDS<0.5 or <1 based on the population reference, HV SDS<- 1 based on the KIGS expected HV curve (HV Ranke SDS), studentized residual (SR) <- 1 in the KIGS first-year prediction model.

Results: ∆Ht SDS<0.5 gave the highest percentage poor responders (37% SGA, 26% GHD). Although % poor responders were comparable for ∆Ht SDS<0.3, HV SDS<+ 0.5, HV SDS<+ 1, SR<- 1, and HV Ranke SDS<- 1, these criteria did not always identify the same patients as poor responders. Among the poor growth responders 24% SGA and 14% GHD patients had an IGF-1 increase < 40%.

Conclusions: The different response criteria yield high but comparable percentages poor responders, but identify different patients. This study does not provide evidence that one criterion is better than another. A limited IGF-1 generation is not the major reason for a poor growth response in the first year of GH treatment in SGA and GHD children.

Trial registration: Retrospectively registered.

Keywords: Children; First-year response; Growth hormone deficiency; Growth hormone treatment; Small for gestational age.

Conflict of interest statement

The data were retrieved from the Belgian Registry of children treated with GH (BELGROW), which is administrated by BESPEED since 1985. The Registry stores coded data and informed consent was secured prior to data entry.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Percentage of poor growth responders after first-year GH treatment in prepubertal children according to various criteria in SGA and GHD patients. SGA = small for gestational age; GHD = growth hormone deficiency; SDS = standard deviation score; ∆Ht = first-year gain in height; HV = height velocity; SR = studentized residual. * HV #p < 0,01 vs. ∆Ht SDS < 0.3, HV SDS < 0.5, SR < − 1, HV Ranke SDS < − 1; @p < 0,05 vs. ∆Ht SDS < 0.3, HV SDS < 0.5, HV Ranke SDS < − 1
Fig. 2
Fig. 2
Number of poor responders for SGA patients (bold) and GHD patients (italic). SGA = small for gestational age; GHD = growth hormone deficiency; SDS = standard deviation score; ∆Ht = first-year gain in height; HV = height velocity; SR = studentized residual. * HV 

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