GROWTH-HORMONE TREATMENT OF SHORT CHILDREN BORN SMALL-FOR-GESTATIONAL-AGE - THE NORDIC MULTICENTER TRIAL

The aims of this study were to evaluate the efficacy and safety of dif ferent doses of growth hormone (GH) treatment in prepubertal short chi ldren born small-for-gestational-age (SGA). Forty-eight children born SGA from Sweden, Finland, Denmark and Norway were randomly allocated t o three groups: a control group of 12 children received no treatment f or 2 y, one group was treated with GH at 0.1 IU/kg/d (n = 16), and one group was treated with GH at 0.2 IU/kg/d (n = 20). In total 42 childr en completed 2 y of follow-up, and 24 children from the treated groups completed 3 y of treatment. Their mean (SD) age at the start of the s tudy was 4.69 (1.61)y and their mean (SD) height was -3.16 (0.70) stan dard deviation scores (SDS). The children remained prepubertal during the course of the study. No catch-up growth was observed in the untrea ted group, but a clear dose-dependent growth response was found in the treated children. After the third year of treatment, the group receiv ing the higher dose of GH, achieved their target height. The major det erminants of the growth response were the dose of GH used, the age at the start of treatment (the younger the child, the better the growth r esponse) and the family-corrected individual height deficit (the highe r the deficit, the better the growth response). Concentration of insul in-like growth factor-I (IGF-I) and IGF-binding protein-3 increased du ring treatment. An increase in insulin levels was found without negati ve effects on fasting glucose levels or glycosylated haemoglobin level s. GH treatment was well tolerated. In conclusion, short prepubertal c hildren born SGA show a dose-dependent growth response to GH therapy, and their target height SDS can be achieved within 3 y of treatment gi ven GH at 0.2 IU/kg/d. However, the long-term benefit of different reg imens of C-H treatment in children born SGA remains to be established.