ESPE Abstracts

Introduction: Children born small for gestational age (SGA) may present permanent short stature. Recombinant human Growth Hormone (rhGH) treatment is recommended for those without spontaneous catch-up growth, however it is not universally available in the Brazilian health care system. Response to treatment may be different across populations since there are many etiologies to SGA birth.

Objective: to evaluate adult height and define the factors involved in its attainment in patients born SGA treated with rhGH in southern Brazil. Method: retrospective study including data of SGA children followed in a pediatric endocrinology center. Inclusion criteria: SGA birth (group A with birth length or weight <-2.0 standard deviation score, SDS; group B with birth length or weight <10th percentile or <-1.28 SDS), absence of catch-up growth until 4 years, rhGH treatment for more than 12 months, and registered adult height. Group B patients were born before the first published consensus on SGA birth. Height SDS were calculated using the World Health Organization standards and birth size SDS was calculated using Intergrowth-21st (gestational age ≥33 weeks). Patients with uncontrolled chronic diseases, genetic syndromes, and growth hormone deficiency (GH peak <5ng/mL) were excluded. Positive response was defined as an adult height increase of ≥0.6 SDS from the initial height.

Results: Twenty-four patients (14 boys) were included, mean gestational age 38.0 (33.0-40.0) weeks, birth weight -1.33±0.91 SDS and birth length -2.4±0.7 SDS, treated with rhGH since 10.3±2.6 years during 5.4±2.3 years, and 18 patients (75%) received gonadotropin-releasing hormone analogs due to late treatment initiation as recommended by the current consensus. Height SDS increased from -2.6±0.4 to -1.2±0.6 SDS, similar to target height SDS (-1.3±0.9; P = 0.28), despite the delayed age of treatment initiation. Although 18 children were considered positive responders, 6 did not reach height SDS >-2.0. Adult height was correlated to height SDS increment and growth velocity during the first year of treatment. No differences were observed between children defined as SGA by birth weight or length <10th percentile or by weight or length <-2.0 SDS.

Conclusion: in this cohort of short children born SGA, rhGH improved adult height, even with late treatment. As being born SGA encompasses a wide variety of causes, the response to rhGH therapy might be variable, and this population showed similar benefits to those reported worldwide. These results may contribute to the availability of rhGH in this population, where access to treatment is not yet universally available.