Results of growth trophic therapy in children with short bowel syndrome.
OBJECTIVE
In addition to the structural, ultrastructural, and functional changes that occur after extensive enterectomy or in utero bowel loss that results in short bowel syndrome (SBS), a complex array of humoral responses take place that may also affect adaptation of the remaining small intestine as well as nutritional status or growth. These include alterations in the levels of circulating hormones and trophic substances such as growth hormone (GH) and insulinlike growth factors (IGF-1 and IGFBP-3). The purpose of this investigation is to report on the management/treatment of 3 children with SBS (>4 years in duration) and growth failure.


METHODS
Serum measures of growth factors and the response to GH stimulation after an arginine insulin tolerance test (AITT) were determined. Weight and height z-scores as well as linear growth velocity were calculated annually pre- and postinitiation of medication therapy.


RESULTS
Patient 1 (boy, 8.5 years old, midgut volvulus, 18-cm bowel) was found to be GH deficient, whereas patients 2 (girl, 12.5 years old, gastroschisis, 70-cm bowel) and 3 (boy, 9 years old, jejunal atresia, 21 cm bowel) were found to have limited GH responsiveness. Subsequently, treatment with GH (1) and growth releasing factor (GRF; 2 & 3) was prescribed. Z-scores for both weight and height improved over time. Positive linear growth velocity was observed from initiation of therapy (<0.5 cm/yr for all) to more than 3 years of treatment (mean 1, 4.7 cm/yr; 2, 8.7 cm/yr; 3, 5.0 cm/yr [age adjusted normals >4.5, >8.5, and >4.9 cm/yr, respectively]). All patients received a regular diet with oral supplements, whereas 2 received parenteral nutrition support for about 1 year.


CONCLUSIONS
In children with medically refractory SBS, it is not only important to offer trophic factors but also essential that sufficient nutrient substrate be provided to achieve adequate growth.
Nucci
Anita M
AM
Clinical Nutrition Department & Intestinal Care Center, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
Finegold
David N
DN
Yaworski
Jane Anne
JA
Kowalski
Lori
L
Barksdale
Edward M
EM
D001827:Body Height; D001835:Body Weight; D002648:Child; D019587:Dietary Supplements; D005260:Female; D006130:Growth Disorders / Q000209:etiology / Q000628:therapy*; D013007:Growth Hormone-Releasing Hormone / Q000627:therapeutic use; D006133:Growth Substances / Q000097:blood / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood / Q000627:therapeutic use; D007334:Insulin-Like Growth Factor I / Q000627:therapeutic use; D008297:Male; D044623:Nutrition Therapy; D010289:Parenteral Nutrition, Total; D012778:Short Bowel Syndrome / Q000150:complications*
D006133:Growth Substances; D018972:Insulin-Like Growth Factor Binding Protein 3; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D013007:Growth Hormone-Releasing Hormone