medwireNews: Very early growth hormone (GH) treatment in children born small for gestational age (SGA) results in significant improvements in their height standard deviation score (SDS) during 2 years of treatment, shows a randomised trial.

The patients in the trial had a baseline height SDS below –2 and were recruited before the age of 30 months. The 21 randomly assigned to receive GH (0.035 mg/kg per day) were aged an average of 24.9 months at baseline, and the 22 untreated patients were an average of 24.4 months.

During 2 years of treatment, patients in the untreated control group achieved some catch-up growth, with a change in height SDS of 0.43. But GH-treated patients achieved a significantly larger improvement, of 1.63.

Patients in the treated group grew an average of 19.92 cm versus 14.34 cm in the control group, and 10 treated patients achieved a height SDS above –2, compared with just one of the control patients. They also had a significantly greater improvement in head circumference SDS, relative to the control group, which the researchers say may have implications for cognition.

Treatment benefits were already apparent after 1 year of treatment, with the height SDS in the treated and untreated groups changing by a respective 1.03 and 0.14. At this point, GH-treated children had significantly greater growth velocity SDS than those in the control group, but this was no longer significant at 24 months.

Boys in the GH-treatment group achieved a larger height SDS change than girls, at 2.54 versus 1.36, but this was also true in the control group, at 0.55 versus 0.20.

Jean De Schepper (Universitair Ziekenhuis Brussel, Belgium) and co-researchers note that US regulations allow treatment of SGA children from the age of 2 years, versus 4 years in Europe. However, they say that in practice treatment is often not started until about the age of 8 years, irrespective of regulations.

“This is too late to facilitate height normalization and results in only a moderate height gain for most patients”, they write in Clinical Endocrinology.

Patients in the GH-treated group had more reported adverse events than those in the control group, which the researchers say may be partly due to underreporting by families of children who were not receiving treatment. Overall, they found the safety profile of GH to be as expected.

The team concludes that early GH treatment “promoted a rapid growth recovery” in SGA children, but cautions that “the lack of follow-up in the GH group after the age of 30 months does not permit conclusion that early treatment improves final height.”

By Eleanor McDermid, Senior medwireNews Reporter

Clin Endocrinol 2015; Advance online publication

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