C H A P T E R 3 study was to investigate if these metabolic effects could also be seen in SGA chil-‐ dren treated with rhGH after 6 weeks and whether these effects are also a predic-‐ tive tool for growth response after one year. Importance of the study Until now, height measurement during a period of one year of treatment with rhGH is recommended for a reliable evaluation of the growth response. Because the eval-‐ uation of the effect lasts such a long time, some children are unnecessarily treated with rhGH, consisting of daily injections. Besides, growth hormone therapy is an expensive treatment. To prevent unnecessary treatment, the prediction of the effect of rhGH therapy on a short term basis is important. The aim of this study was to find a good prognostic tool for prediction of the growth response to rhGH therapy. Methods Subjects In this study children with GHD or SGA were included who were indicated for rhGH treatment according to the Dutch Growth Research Foundation. GHD children have to meet the following criteria: • Negative deviation of the growth curve • Delayed bone maturation measured by X-‐ray of the left hand • GH concentration < 20mU/l in 2 stimulation tests • Insulin-‐like growth factor 1 (IGF-‐1) < -‐2 SD • Inclusion criteria for SGA children to receive GH therapy were: • Birth length or weight < -‐2 SD for gestational age • Actual height < -‐2.5 SD according to the standard reference values14,15 • Age ≥ 4 years • Bone maturation ≤ 13 years for girls or ≤ 15 years for boys • No signs of catch-‐up growth in previous year • Actual height deviates > 1 SD from target height (TH) • Children were excluded if other reasons than those related to GHD or SGA for growth retardation were present • SGA children with GHD are excluded in this study Parents and children were informed about the nature of the study and written con-‐ sent was obtained. The study was approved by the Medical Ethical Committee of the Maastricht University Medical Centre (MUMC). 46
Proefschrift binnenwerk Manon Ernst_DEF.indd
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