Abstract
BackgroundMathematical models can be developed to predict growth in short children treated with growth hormone (GH). These models can serve to optimize and individualize treatment in terms of height outcomes and costs. The aims of this study were to compile existing prediction models for short children born SGA (SGA), to develop new models and to validate the algorithms.MethodsExisting models to predict height velocity (HV) for the first two and the fourth prepubertal years and during total pubertal growth (TPG) on GH were applied to SGA children from the KIGS (Pfizer International Growth Database) - 1st year: N = 2340; 2nd year: N = 1358; 4th year: N = 182; TPG: N = 59. A new prediction model was developed for the 3rd prepubertal year based upon 317 children by means of the all-possible regression approach, using Mallow's C(p) criterion.ResultsThe comparison between the observed and predicted height velocity showed no significant difference when the existing prediction models were applied to new cohorts. A model for predicting HV during the 3rd year explained 33% of the variability with an error SD of 1.0 cm/year. The predictors were (in order of importance): HV previous year; chronological age; weight SDS; mid-parent height SDS and GH dose.ConclusionsModels to predict growth to GH from prepubertal years to adult height are available for short children born SGA. The models utilize easily accessible predictors and are accurate. The overall explained variability in SGA is relatively low, due to the heterogeneity of the disorder. The models can be used to provide patients with a realistic expectation of treatment, and may help to identify compliance problems or other underlying causes of treatment failure.
Highlights
Mathematical models can be developed to predict growth in short children treated with growth hormone (GH)
Small for gestational age (SGA) is a working diagnostic term used to describe foetuses or newborn infants who have a lower weight and/or length than what is normal for their gestational age, in the absence of any other specific diagnosis or reason for their small stature [1]
In order to avoid the effects of initial catch-up growth on total pubertal growth (TPG) only patients who were treated with GH for a total of at least 5 years and who were treated at least two years before puberty onset were included in the analysis of TPG
Summary
Mathematical models can be developed to predict growth in short children treated with growth hormone (GH). These models can serve to optimize and individualize treatment in terms of height outcomes and costs. In the majority of children born SGA catchup growth occurs by 2 years of age, in about 10% catchup growth does not occur The aim of this study is to test the existing prediction models and to develop additional growth prediction model from the KIGS database, to allow an optimisation and individualization of GH treatment from pre-pubertal onset to the end of the growth phase in SGA
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