Height outcomes in children born small for gestational age (SGA) from combined CrescNet and REPAR cohorts: The impact of either spontaneous or growth hormone-induced catch-up growth

Aneta Kodytková; Christoph Beger; Ruth Gausche; Stanislava Koloušková; Jan Lebl; Roland Pfäffle

P1-256

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ESPE Abstracts (2024) 98 P1-256

ESPE2024 Poster Category 1 Growth and Syndromes 3 (10 abstracts)

Height outcomes in children born small for gestational age (SGA) from combined CrescNet and REPAR cohorts: The impact of either spontaneous or growth hormone-induced catch-up growth

Aneta Kodytková ¹ , Christoph Beger ² , Ruth Gausche ² , Stanislava Koloušková ¹ , Jan Lebl ¹ & Roland Pfäffle ^2,3

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¹Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic. ²Growth Network CrescNet, Medical Faculty, Leipzig University, Leipzig, Germany. ³Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany

Background: Approximately 5 % of children are born SGA (birth weight/length below -2 SDS), anyway most experience an early spontaneous catch-up growth (CUG). About 15 % remain short during childhood and end up as short adults. Growth hormone (GH) treatment in general improves their growth.

Objectives: We analyzed growth patterns in four SGA cohorts from two large databases: Those with spontaneous CUG, those who failed to catch-up and were either untreated or treated with GH since childhood or later during puberty.

Methods: Growth data of 10,196 children and adolescents born SGA from German CrescNet and Czech REPAR databases, with known birth data, near final height, and regular follow-up visits were available. They either (1) started GH treatment in childhood (before 10 y/o in girls, 11 y/o in boys), or (2) later in puberty, or (3) remain untreated without CUG, or (4) untreated with CUG. Generalized additive models (GAM) with P-splines for smoothing were created to describe height SDS change. Weights were introduced to account for repeating measurements.

Results: All groups had similar gestational age (38.4 weeks, 2.6 SD). These treated since childhood achieved similar growth results as children with spontaneous CUG. The effect of GH treatment introduced in puberty was poor, similar as in untreated children without CUG (Table).

Table. Lengths/heights SDS over time in all groups, estimated with GAM models. Data shown as mean SDS (95% CI).
	GH treatment since childhood			GH treatment since puberty			Untreated, no catch-up			Untreated, spontaneous catch-up
Age [y/o]	Female n = 699	Male n = 888	All	Female n = 204	Male n = 252	All	Female n = 420	Male n = 542	All	Female n = 3644	Male n = 3547	All
0	-2.9	-3.2	-3.0	-2.4	-2.6	-2.5	-2.7	-2.8	-2.8	-2.0	-1.9	-2.0
8	-2,2	-2.2	-2.2	-2.8	-2.9	-2.8	-2.7	-2.6	-2.6	-0.8	-1.0	-0.9
12	-1.7	-1.4	-1.5	-2.7	-2.4	-2.5	-2.2	-2.1	-2.2	-0.7	-0.6	-0.7
16	-2.2	-2.0	-2.1	-2.0	-2.7	-2.3	-2.6	-2.7	-2.6	-0.6	-1.1	-0.9
Delta height SDS (0-16 y/o):	0.7 (0.3;1.2)	1.2 (1.0;1.5)	1.0 (0.7;1.2)	0.4 (0.0;0.8)	0.1 (0.4;0.2)	0.2 (-0.1;0.4)	0.2 (0.3;-0.6)	0.1 (-0.3;0.6)	0.1 (-0.2;0.5)	1.4 (1.2;1.6)	0.8 (0.6;1.0)	1.1 (1.0;1.2)
p-value	0.075	<0.001	<0.001	n.s.	n.s.	n.s.	n.s.	n.s.	n.s.	<0.001	<0.001	<0.001

Conclusion: Following GH treatment started early in childhood, SGA children achieve similar height as children with spontaneous catch-up. Therapy started at pubertal age fails to improve height.