Growth abnormalities persist in newly diagnosed children with crohn disease despite current treatment paradigms.
OBJECTIVE
We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies.


METHODS
Clinical and growth data were prospectively obtained on an inception cohort younger than 16 years old at diagnosis and Tanner I to III during the study.


RESULTS
In all, 176 children (mean age 10.1 years; 65% male) with mild (33%) or moderate/severe (67%) disease at diagnosis were studied. Disease activity at 1 year was inactive/mild (89%) or moderate/severe (11%). First-year treatments included immunomodulators (60%), corticosteroids (77%), 5-aminosalicylates (61%), infliximab (15%), and enteral nutrition (10%). By 2 years, 86% had received immunomodulators and 36% infliximab. Mean height z scores at diagnosis, 1 year, and 2 years were -0.49 +/- 1.2 standard deviations (SDs), -0.50 +/- 1.2, and -0.46 +/- 1.1, respectively. Of the subjects, 10%, 8%, and 6.5% had height z scores less than -2 SD at diagnosis, 1 year, and 2 years. A height velocity z score less than -1SD was seen in 45% of subjects at 1 year and 38% at 2 years. The mean height velocity z score, however, increased between 1 and 2 years from -0.71 to 0.26 (P < 0.03). Corticosteroid use greater than 6 months in the first year was associated with abnormal height velocity at 1 year (adjusted odds ratio = 4.5; 95% confidence interval [CI] = 2.2-9.6). No statistically significant effect on height velocity z scores was noted when comparing those receiving or not receiving infliximab.


CONCLUSIONS
Growth delay persists in many children with CD following diagnosis, despite improved disease activity and the frequent use of immunomodulators and biologics. Additional strategies to improve growth outcomes require development.
Pfefferkorn
Marian
M
Riley Hospital for Children, Indianapolis, IN 46202, USA. mdelrosa@iupui.edu
Burke
Georgine
G
Griffiths
Anne
A
Markowitz
James
J
Rosh
Joel
J
Mack
David
D
Otley
Anthony
A
Kugathasan
Subra
S
Evans
Jonathan
J
Bousvaros
Athos
A
Moyer
M Susan
MS
Wyllie
Robert
R
Oliva-Hemker
Maria
M
Carvalho
Ryan
R
Crandall
Wallace
W
Keljo
David
D
Walters
T D
TD
LeLeiko
Neal
N
Hyams
Jeffrey
J
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001827:Body Height / Q000187:drug effects / Q000502:physiology; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006128:Growth / Q000187:drug effects* / Q000502:physiology; D006130:Growth Disorders / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D000069285:Infliximab; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012741:Sexual Maturation; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab