Growth Abnormalities Persist in Newly Diagnosed Children With Crohn Disease Despite Current Treatment Paradigms
| Autor: | Thomas D. Walters, Ryan Carvalho, Neal Leleiko, Wallace Crandall, David R. Mack, Athos Bousvaros, Joel R. Rosh, Anne M. Griffiths, Maria Oliva-Hemker, Marian D. Pfefferkorn, Georgine Burke, Subra Kugathasan, David J. Keljo, Jonathan Evans, James Markowitz, M. Susan Moyer, Robert Wyllie, Jeffrey S. Hyams, Anthony Otley |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Adolescent Growth data Anti-Inflammatory Agents Growth Newly diagnosed Severity of Illness Index Gastroenterology Cohort Studies Enteral Nutrition Crohn Disease Adrenal Cortex Hormones Internal medicine Confidence Intervals Odds Ratio Prevalence medicine Humans Prospective Studies Sexual Maturation Child Growth Disorders business.industry Crohn disease Antibodies Monoclonal Nutritional status Hepatology medicine.disease INCEPTION COHORT Ulcerative colitis Body Height Infliximab Treatment Outcome El Niño Pediatrics Perinatology and Child Health Female business |
| Zdroj: | Journal of Pediatric Gastroenterology & Nutrition. 48:168-174 |
| ISSN: | 0277-2116 |
| Popis: | We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies.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.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 (P0.03). 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.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. |
| Databáze: | OpenAIRE |
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