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Impact of Steroid Therapy on Early Growth in Infants with Biliary Atresia: The Multicenter Steroids in Biliary Atresia Randomized Trial.
Alonso, Estella M; Ye, Wen; Hawthorne, Kieran; Venkat, Veena; Loomes, Kathleen M; Mack, Cara L; Hertel, Paula M; Karpen, Saul J; Kerkar, Nanda; Molleston, Jean P; Murray, Karen F; Romero, Rene; Rosenthal, Philip; Schwarz, Kathleen B; Shneider, Benjamin L; Suchy, Frederick J; Turmelle, Yumirle P; Wang, Kasper S; Sherker, Averell H; Sokol, Ronald J; Bezerra, Jorge A; Magee, John C.
Afiliação
  • Alonso EM; Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: ealonso@luriechildrens.org.
  • Ye W; Department of Biostatistics, University of Michigan, Ann Arbor, MI.
  • Hawthorne K; Arbor Research Collaborative for Health, Ann Arbor, MI.
  • Venkat V; Children's Hospital of Pittsburgh, Pittsburgh, PA.
  • Loomes KM; Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Mack CL; Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.
  • Hertel PM; Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX.
  • Karpen SJ; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, GA.
  • Kerkar N; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA; Division of Pediatric Gastroenterology, The Mount Sinai School of Medicine, New York, NY.
  • Molleston JP; Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine, Rylie Hospital for Children, Indianapolis, IN.
  • Murray KF; Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Washington and Seattle Children's, Seattle, WA.
  • Romero R; Pediatrics, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, GA.
  • Rosenthal P; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA.
  • Schwarz KB; Johns Hopkins School of Medicine, Baltimore, MD.
  • Shneider BL; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
  • Suchy FJ; Children's Hospital Research Institute, Children's Hospital Colorado, Aurora, CO.
  • Turmelle YP; Washington University School of Medicine, St. Louis, MO.
  • Wang KS; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA.
  • Sherker AH; Liver Diseases Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
  • Sokol RJ; Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.
  • Bezerra JA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
  • Magee JC; Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
J Pediatr ; 202: 179-185.e4, 2018 11.
Article em En | MEDLINE | ID: mdl-30244988
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.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Atresia Biliar / Corticosteroides / Insuficiência de Crescimento / Sarcopenia Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Atresia Biliar / Corticosteroides / Insuficiência de Crescimento / Sarcopenia Idioma: En Ano de publicação: 2018 Tipo de documento: Article