ESPE Abstracts

Fetal alcohol syndrome (FAS) is established based on the presence or absence of characteristic facial features, prenatal/postnatal growth deficiency (height and/or weight < 10th percentile), deficient brain growth, neurobehavioral impairment, and maternal alcohol consumption during pregnancy. There have been no reports of growth hormone (GH) treatment in FAS; therefore, we report a case of GH treatment on FAS for small for gestational (SGA) short stature. The patient was a girl born at 37 weeks and 5 days of gestation with weight of 2064 g (1.6th percentile), height of 41.5 cm (0.3th percentile), and an Apgar score of 3/4. Distinct facial features, growth deficiency, and mental retardation were observed. The mother was diagnosed as alcohol dependence in psychiatric clinic. She was diagnosed with FAS. Her height was 78 cm (-4.18SD) and weight was 7.305 kg (-3.62SD) at 3 years of age. GH stimulation test was performed for the short stature and GH secretion was normal. GH treatment (0.191 mg/kg/week) was started as an SGA short stature. Weight gain and growth velocity was poor although GH treatment was started. Nutritional assessment was performed in hospital due to concerns about the worsening dietary environment at home. The deterioration of eating habits occurred at home, which was considered as a state of inadequate nutrition. Improvements in eating habits were observed after children were transferred from home to the child’s center. IGF-1 generation test was performed to ensure that GH was properly administered to her, then IGF-1 level increased from 59 to 175 ng/mL. It was found that GH was not administered properly at home, then she was started to administer GH daily at the child’s center. The dose of GH was increased to 0.43 mg/kg/week, however, the growth velocity remained unchanged, and the height was 98.4 cm (-4.26 SD) at 7 years and 2 months old. In the blood examination, there was a slight increase transaminase and HbA1c. Postnatal growth failure is affected by both nutrition status and living conditions, but the reasons why growth velocity do not improve in FAS are not well understood. Nutritional status and living conditions were improved, and GH was administered as SGA short stature, but without improvement in growth velocity and short stature.