Impact of Steroid Therapy on Early Growth in Infants with Biliary Atresia: The Multicenter Steroids in Biliary Atresia Randomized Trial - 23/10/18
, Wen Ye, PhD 2, Kieran Hawthorne, MS 3, Veena Venkat, MD 4, Kathleen M. Loomes, MD 5, Cara L. Mack, MD 6, Paula M. Hertel, MD 7, Saul J. Karpen, MD, PhD 8, Nanda Kerkar, MD 9, 10, Jean P. Molleston, MD 11, Karen F. Murray, MD 12, Rene Romero, MD 13, Philip Rosenthal, MD 14, Kathleen B. Schwarz, MD 15, Benjamin L. Shneider, MD 16, Frederick J. Suchy, MD 17, Yumirle P. Turmelle, MD 18, Kasper S. Wang, MD 9, Averell H. Sherker, MD 19, Ronald J. Sokol, MD 6, Jorge A. Bezerra, MD 20, John C. Magee, MD 21and the
ChiLDReN Network
Abstract |
Objective |
To investigate the impact of corticosteroid therapy on the growth of participants in the Steroids in Biliary Atresia Randomized Trial (START) conducted through the Childhood Liver Disease Research Network. The primary analysis in START indicated that steroids did not have a beneficial effect on drainage in a cohort of infants with biliary atresia. We hypothesized that steroids would have a detrimental effect on growth in these infants.
Study design |
A total of 140 infants were enrolled in START, with 70 randomized to each treatment arm: steroid and placebo. Length, weight, and head circumference were obtained at baseline and follow-up visits to 24 months of age.
Results |
Patients treated with steroids had significantly lower length and head circumference z scores during the first 3 months post-hepatoportoenterostomy (HPE), and significantly lower weight until 12 months. Growth trajectories in the steroid and placebo arms differed significantly for length (P < .0001), weight (P = .009), and head circumference (P < .0001) with the largest impact noted for those with successful HPE. Growth trajectory for head circumference was significantly lower in patients treated with steroids irrespective of HPE status, but recovered during the second 6 months of life.
Conclusions |
Steroid therapy following HPE in patients with biliary atresia is associated with impaired length, weight, and head circumference growth trajectories for at least 6 months post-HPE, especially impacting infants with successful bile drainage.
Trial registration |
ClinicalTrials.gov: NCT00294684.
Le texte complet de cet article est disponible en PDF.Keywords : chronic liver disease, sarcopenia, failure to thrive
Abbreviations : ChiLDReN, HPE, START
Plan
| Supported by U01 grants from the National Institute of Diabetes and Digestive and Kidney Diseases (DK 62445 [Mount Sinai School of Medicine], DK 62497 [Cincinnati Children's Hospital Medical Center], DK 62470 [Children's Healthcare of Atlanta], DK 62481 [The Children's Hospital of Philadelphia], DK 62456 [The University of Michigan], DK 84536 [Riley Hospital for Children], DK 84575 [Seattle Children's Hospital], DK 62500 [UCSF Children's Hospital], DK 62503 [Johns Hopkins School of Medicine], DK 62466 [Children's Hospital of Pittsburgh of UPMC], DK 62453 [Children's Hospital Colorado], DK 62452 [Washington University School of Medicine], DK 84538 [Children's Hospital Los Angeles], DK 62436 [Ann & Robert H Lurie Children's Hospital of Chicago], DK103149 [Texas Children's Hospital], DK103140 [University of Utah]). The project was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001878 [The Children's Hospital of Philadelphia], UL1TR000077 [Cincinnati Children's Hospital Medical Center, Cincinnati, OH], UL1TR001082 [Children's Hospital Colorado]. All support is provided without restrictions on publications. The authors declare no conflicts of interest. |
|
| Portions of this study were presented at the 67th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting, November 11-15, 2016, Boston, Massachusetts. |
Vol 202
P. 179 - novembre 2018 Retour au numéro
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