ESPE Abstracts (2016) 86 RFC3.6

Priority Target Conditions of Growth-Monitoring in Children: Toward Consensus

Pauline Scherdela,b, Rachel Reynaudc, Christine Pietrementd, Jean-François Salaüne, Marc Bellaïchef, Michel Arnouldg, Bertrant Chevallierh, Jean-Claude Careli, Hugues Piloquetj, Emmanuel Jobezk, Jacques Cheymoll, Barbara Heudea & Martin Chalumeaub,m


aINSERM, CRESS U1153, Equipe de recherche sur les Origines précoces de la santé et du développement de l’enfant (ORCHAD), Université Paris-Descartes, Villejuif, France; bINSERM CRESS U1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Paris-Descartes, Paris, France; cSociété Française d’Endocrinologie et Diabétologie Pédiatrique, Université Aix-Marseille, Marseille, France; dSociété de Néphrologie Pédiatrique, Faculté de médecine de Reims, Reims, France; eAssociation Française de Pédiatre Ambulatoire, Commission recherche, Gradignan, France; fGroupe Francophone d’Hépato-Gastroentérologie et Nutrition Pédiatrique, Hôpital Robert-Debré, AP-HP, Paris, France; gSociété Française de Médecine Générale, Commission recherche, Orléans, France; hGroupe de Pédiatrie Générale, Société Française de Pédiatrie, Hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, France; iSociété Française d’Endocrinologie et Diabétologie Pédiatrique, Université Paris-Diderot, Paris, France; jGroupe Francophone d’Hépato-Gastroentérologie et Nutrition Pédiatrique, CHU Nantes, Nantes, France; kSociété de Formation Thérapeutique du Généraliste, Commission recherche, Paris, France; lCommission Santé publique et Pédiatrie sociale, Société Française de Pédiatrie, Clichy, France; mHôpital Necker-Enfants malades, Université Paris Descartes et AP-HP, Paris, France


Background: Growth monitoring of apparently healthy children aims at early detection of severe underlying conditions. Strong empirical evidence shows that current practices of growth monitoring are suboptimal. Practice standardisation with validated tools requires answering two questions: Which conditions should be targeted? How should abnormal growth be defined?

Objective and hypotheses: To obtain consensus on a short list of priority target conditions of growth monitoring.

Method: The RAND consensus method involved a panel of appointed experts from all French academic societies involved in the diagnosis and management of growth disorders, from primary care providers to experts in paediatric endocrinology, nephrology and gastroenterology, and members of parent associations. Participants were asked to select conditions fulfilling 4 previously established criteria [Scherdel, Lancet Diabetes Endocrinol 2016]: an “important health problem” in terms of their incidence and related morbidity and mortality, a natural history including a long paucisymptomatic period during which the main clinical expression was auxological, a high level of evidence for a relationship between early diagnosis and a more favourable outcome, and diagnosis criteria that are both robust and independent of auxological parameters that can be used to define abnormal growth.

Results: After the first two rounds of consensus, the panel selected 8 conditions: growth hormone deficiency with pituitary stalk interruption syndrome, Turner syndrome, craniopharyngioma, hypothalamic-optochiasmatic astrocytoma, celiac disease, Crohn disease, renal tubulopathy and chronic renal failure.

Conclusion: This national consensus will now be used to (1) build trans-speciality European consensus and (2) refine and optimize the current clinical decision rules proposed to define abnormal growth.