Skip Navigation LinksHome > February 2009 - Volume 48 - Issue 2 > Growth Abnormalities Persist in Newly Diagnosed Children Wit...
Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e318175ca7f
Original Articles: Gastroenterology

Growth Abnormalities Persist in Newly Diagnosed Children With Crohn Disease Despite Current Treatment Paradigms

Pfefferkorn, Marian*; Burke, Georgine; Griffiths, Anne; Markowitz, James§; Rosh, Joel; Mack, David||; Otley, Anthony**; Kugathasan, Subra††; Evans, Jonathan‡‡; Bousvaros, Athos§§; Moyer, M Susan¶¶; Wyllie, Robert||||; Oliva-Hemker, Maria***; Carvalho, Ryan†††; Crandall, Wallace‡‡‡; Keljo, David§§§; Walters, TD; LeLeiko, Neal¶¶¶; Hyams, Jeffrey

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Objectives: We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies.

Patients and 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.

© 2009 Lippincott Williams & Wilkins, Inc.


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