Puberty and growth in patients with pediatric intestinal failure | Hypothesis | Pediatric intestinal failure (PIF) patients have decreased pubertal growth and delayed onset of puberty | Retrospective chart review | Single institution | From 2014 to 2020 | >8 years old w/ short bowel syndrome (SBS) and PIF | 110 patients | 19 fully parenteral nutrition (PN) dependent | 18 partially PN dependent | 73 PN independent | Evaluated: | Peak height velocity (PHV) | Age at PHV | and compared with | CDC 50th percentiles | Results: | mean PHV ~ in both groups | mean age at PHV ↓ in PIF patients | mean PHV ↑ in both groups | mean age at PHV ↓ in PIF patients | Conclusion: | Patients with PIF have a robust PHV and do not have delayed onset of puberty or pubertal growth spurt compared to established norms and current guidelines. | https://doi.org/10.1016/j.jpedsurg.2022.01.057 | Source: Katherine Culbreath, MD et al. | Department of Surgery & Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA | @cecilipstick | @emtomash | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Puberty and growth in patients with pediatric intestinal failure
Infographic · Jul 2022 · 1 min read
In brief
In brief
This retrospective study of 110 pediatric intestinal failure patients found that pubertal onset occurred earlier than population norms, with preserved peak height velocity, challenging assumptions about delayed development in this population. Despite normal pubertal progression, 20% had significant short stature, emphasizing the critical need for optimizing prepubertal growth in intestinal rehabilitation programs.
- Pediatric intestinal failure does not delay puberty; patients reach pubertal onset earlier than population norms, especially males.
- Peak height velocity occurs younger in PIF patients (males 12.3y vs 13.4y; females 10.7y vs 11.7y) but velocity magnitude is preserved.
- 20% of PIF patients have significant short stature (Z-score <-2), emphasizing need to optimize prepubertal linear growth.
- Male PIF patients show significantly higher peak height velocity than CDC norms (9.27 vs 7.91 cm/yr), females show similar velocity.
- Early pubertal timing in PIF shortens growth window; aggressive nutritional optimization before puberty is critical for final height.
Written by the GCMD Library team from the infographic.
The infographic uses a teal, gray, and yellow color scheme with illustrated icons including a thought bubble, clipboard, healthcare provider figure, and gender symbols. Information is organized in distinct sections flowing from hypothesis at top through methods, results, and conclusion at bottom. Key findings are highlighted with arrows indicating directional changes.
Background
Pediatric intestinal failure (PIF) affects nutrition, metabolism, and endocrine development, but its downstream impact on puberty is unknown.
Methods
A retrospective review was performed of patients age >8 years with PIF managed at an intestinal rehabilitation program. Outcomes of interest were peak height velocity (PHV), age at PHV, and age at pubertal onset (Tanner stage 2). Outcomes were stratified by sex and compared to established norms.
Results
Of 110 patients with PIF, 54.5% were male. Compared to the CDC 50th percentile, PHV in PIF patients was similar for females (8.09±2.36 vs. 7.37 cm/yr;p = 0.23) but significantly higher for males (9.27±2.56 vs. 7.91 cm/yr;p = 0.038). Age at PHV in PIF patients was significantly younger for both males (12.31±2.14 vs. 13.38 years;p = 0.049) and females (10.70±1.06 vs. 11.71 years;p = 0.001). PIF patients reached pubertal onset earlier than published norms; this was significant for males (12.41±1.80 vs. 13.44 years;p = 0.014), but not for females (10.45±1.81 vs. -11.15 years;p = 0.13). The mean height-for-age Z-score was -1.2, with 20% of patients having a Z-score less than -2.
Conclusions
Pubertal onset and growth are neither delayed nor diminished in patients with PIF. The high incidence of short stature, however, highlights the importance of optimizing prepubertal linear growth to attain full height potential.