Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis.
OBJECTIVE
To determine the effect of adenoidectomy and/or tonsillectomy ("adenotonsillectomy") upon growth and growth biomarkers, in the context of sleep disordered breathing (SDB). SDB in children, primarily due to adenotonsillar hypertrophy, increases the risk of growth failure.


METHODS
Systematic review and meta-analysis. PubMed, ERIC and Cochrane Reviews databases from January 1980 to November 2007 were searched for studies reporting: pre/post-adenotonsillectomy height and weight changes as percentage increased or decreased, raw data, z scores or centiles, or: IGF-1 and/or IGFBP-3 serum-level changes as z scores or raw data. For anthropometrics, the meta-analysis included studies presenting z scores or centiles.


METHODS
Observational studies.


METHODS
Otherwise healthy children, not selected for obesity.


METHODS
Pre/post-surgery changes in standardised height and weight, and IGF-1 and IGFBP-3.


RESULTS
Of 211 citations identified, 20 met systematic review criteria. SDB was an enrolment criterion in 13 of the studies, and one of several enrolment criteria in three. Meta-analysis findings for pre/post-surgery changes were: standardised height: 10 studies, 363 total children, pooled standardised mean differences (SMD) = 0.34 (95% CI 0.20 to 0.47); standardised weight: 11 studies, 390 total children, pooled SMD = 0.57 (95% CI 0.44 to 0.70); IGF-1: 7 studies, 177 total children, pooled SMD = 0.53 (95% CI 0.33 to 0.73); IGFBP-3: 7 studies, 177 total children, pooled SMD = 0.59 (95% CI 0.34 to 0.83).


CONCLUSIONS
Standardised height and weight, and IGF-1 and IGFBP-3 increased significantly after adenotonsillectomy. Findings suggest that primary care providers and specialists consider SDB secondary to adenotonsillar hypertrophy when screening, treating and referring children with growth failure.
Bonuck
K A
KA
Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Mazer, Bronx, NY 10461, USA. bonuck@montefiore.org
Freeman
K
K
Henderson
J
J
D000233:Adenoidectomy / Q000534:rehabilitation*; D000234:Adenoids / Q000473:pathology; D000293:Adolescent; D000886:Anthropometry; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D005260:Female; D006128:Growth; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D006965:Hyperplasia / Q000150:complications / Q000601:surgery; D007223:Infant; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000601:surgery*; D014068:Tonsillectomy / Q000534:rehabilitation*; D015430:Weight Gain
C515497:IGFBP3 protein, human; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins; D007334:Insulin-Like Growth Factor I