Evaluating treatment effectiveness in small for gestational age children by optimizing growth hormone dose

Abstract

Background. According to world statistics, about 5–10 % of newborns are small for gestational age (SGA). They can have inadequate rates of postnatal growth during first two years of life. This growth deficiency is observed throughout childhood and adolescence, which ultimately leads to short stature in adulthood. The purpose was to analyze the efficacy of different doses of recombinant growth hormone (rGH) therapy in order to correct growth in pre-pubertal children born small for gestational age. Materials and methods. Fifty children born small for gestational age (16 girls and 34 boys with mean age of 6.82 ± 0.36 years) with growth failure were examined. According to the results of clonidine and insulin tests, SGA patients were divided into two groups: group A — children without grown hormone deficiency (n = 34; 68 %), group B — patients with growth hormone deficiency (n = 16; 32 %). The control group included 34 persons (13 girls and 21 boys with mean age of 6.58 ± 0.38 years) with growth hormone deficiency. All patients received rGH treatment starting with a dose of 0.03 mg/kg/day according to the pituitary hormone deficiency protocol, and in case of slow growth rate, the dose was gradually increased to 0.05 mg/kg/day in group B patients. Results. A significant slowdown in growth acceleration in the first 6 months of rGH treatment at dose of 0.033 mg/kg/day was found in SGA patients without grown hormone deficiency (p < 0.05). The rGH treatment at a dose of 0.05 mg/kg/day for the next 6 months showed a statistically significant increase in growth standard deviation score (SDS) of SGA patients without growth hormone deficiency (–2.00 ± 0.14 SDS vs. –2.58 ± 0.15 SDS in the first 6 months with rGH dose of 0.033 mg/kg/day) (p < 0.05). Conclusions. The optimal dose of rGH treatment in small for gestational age children with growth hormone deficiency is 0.033 mg/kg/day, and in SGA patients without growth hormone deficiency — 0.05 mg/kg/day.

Keywords

• small for gestational age
• children
• somatotropin
• growth hormone deficiency
• treatment