Document Detail


Results of growth trophic therapy in children with short bowel syndrome.
MedLine Citation:
PMID:  15017548     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: 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.
Authors:
Anita M Nucci; David N Finegold; Jane Anne Yaworski; Lori Kowalski; Edward M Barksdale
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  39     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-12     Completed Date:  2004-06-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  335-9; discussion 335-9     Citation Subset:  IM    
Affiliation:
Clinical Nutrition Department & Intestinal Care Center, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
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MeSH Terms
Descriptor/Qualifier:
Body Height
Body Weight
Child
Dietary Supplements
Female
Growth Disorders / etiology,  therapy*
Growth Hormone-Releasing Hormone / therapeutic use
Growth Substances / blood,  therapeutic use*
Human Growth Hormone / blood,  therapeutic use
Humans
Insulin-Like Growth Factor Binding Protein 3 / blood,  therapeutic use
Insulin-Like Growth Factor I / therapeutic use
Male
Nutrition Therapy
Parenteral Nutrition, Total
Short Bowel Syndrome / complications*
Chemical
Reg. No./Substance:
0/Growth Substances; 0/Insulin-Like Growth Factor Binding Protein 3; 12629-01-5/Human Growth Hormone; 67763-96-6/Insulin-Like Growth Factor I; 9034-39-3/Growth Hormone-Releasing Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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