Effect of recombinant human growth hormone on intestinal absorption and body composition in children with short bowel syndrome.
This prospective study aimed to establish the effect of recombinant human growth hormone (rhGH) on intestinal function in children with short bowel syndrome (SBS). Eight children with neonatal SBS were included. All were dependent on parenteral nutrition (PN) for >3 years (range, 3.8-11.6 years), with PN providing >50% of recommended dietary allowance for age (range, 50%-65%). The subjects received rhGH (Humatrope) 0.13 mg/kg/d subcutaneously over a 12-week period. The follow-up was continued over a 12-month period after rhGH discontinuation. Clinical and biological assessments were performed at baseline, at the end of the treatment period, and 12 months after the end of treatment. No side effects related to rhGH were observed. PN requirements were decreased in all children during the course of rhGH treatment. Between baseline and the end of treatment, significant increases were observed in concentrations (mean ± standard deviation) of serum insulin-like growth factor 1 (103.1 ± 49.9 µg/L vs 153.5 ± 82.2 µg/L; P < .01), serum insulin-like growth factor-binding protein 3 (1.7 ± 0.6 mg/L vs 2.5 ± 0.9 mg/L; P < .001), and plasma citrulline (16.5 ± 14.8 µmol/L vs 25.2 ± 18.3 µmol/L; P < .05). A median 54% increase in enteral intake (range, 10%-244%) was observed (P < .001) and net energy balance improved significantly (P < .002). It was necessary for 6 children to be maintained on PN or restarted after discontinuation of rhGH treatment, and they remained on PN until the end of the follow-up period. A 12-week high-dose rhGH treatment allowed patients to decrease PN, but only 2 patients could be definitively weaned from PN. Indications and cost-effectiveness of rhGH treatment for SBS pediatric patients need further evaluation.
Goulet
Olivier
O
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Necker-Enfants Malades, University of Paris-René Descartes, Paris, France. olivier.goulet@nck.aphp.fr
Dabbas-Tyan
Myriam
M
Talbotec
Cécile
C
Kapel
Nathalie
N
Rosilio
Myriam
M
Souberbielle
Jean-Claude
JC
Corriol
Odile
O
Ricour
Claude
C
Colomb
Virginie
V
D001823:Body Composition / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D002956:Citrulline / Q000097:blood*; D002149:Energy Intake / Q000187:drug effects; D004734:Energy Metabolism / Q000187:drug effects; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007408:Intestinal Absorption / Q000187:drug effects; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000187:drug effects*; D008297:Male; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D011994:Recombinant Proteins; D012778:Short Bowel Syndrome / Q000097:blood / Q000188:drug therapy / Q000378:metabolism*
D018972:Insulin-Like Growth Factor Binding Protein 3; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D002956:Citrulline; D007334:Insulin-Like Growth Factor I