Impact of Steroid Therapy on Early Growth in Infants with Biliary Atresia: The Multicenter Steroids in Biliary Atresia Randomized Trial

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4 Citations (Scopus)

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.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Biliary Atresia
Steroids
Growth
Head
Therapeutics
Weights and Measures
Drainage
Arm
Placebos
Bile
Liver Diseases
Adrenal Cortex Hormones

Keywords

  • chronic liver disease
  • failure to thrive
  • sarcopenia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{5a82731b30084125a7a379e09b247d21,
title = "Impact of Steroid Therapy on Early Growth in Infants with Biliary Atresia: The Multicenter Steroids in Biliary Atresia Randomized Trial",
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.",
keywords = "chronic liver disease, failure to thrive, sarcopenia",
author = "{ChiLDReN Network} and Alonso, {Estella M.} and Wen Ye and Kieran Hawthorne and Veena Venkat and Loomes, {Kathleen M.} and Mack, {Cara L.} and Hertel, {Paula M.} and Karpen, {Saul J.} and Nanda Kerkar and Jean Molleston and Murray, {Karen F.} and Rene Romero and Philip Rosenthal and Schwarz, {Kathleen B.} and Shneider, {Benjamin L.} and Suchy, {Frederick J.} and Turmelle, {Yumirle P.} and Wang, {Kasper S.} and Sherker, {Averell H.} and Sokol, {Ronald J.} and Bezerra, {Jorge A.} and Magee, {John C.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpeds.2018.07.002",
language = "English (US)",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Impact of Steroid Therapy on Early Growth in Infants with Biliary Atresia

T2 - The Multicenter Steroids in Biliary Atresia Randomized Trial

AU - ChiLDReN Network

AU - Alonso, Estella M.

AU - Ye, Wen

AU - Hawthorne, Kieran

AU - Venkat, Veena

AU - Loomes, Kathleen M.

AU - Mack, Cara L.

AU - Hertel, Paula M.

AU - Karpen, Saul J.

AU - Kerkar, Nanda

AU - Molleston, Jean

AU - Murray, Karen F.

AU - Romero, Rene

AU - Rosenthal, Philip

AU - Schwarz, Kathleen B.

AU - Shneider, Benjamin L.

AU - Suchy, Frederick J.

AU - Turmelle, Yumirle P.

AU - Wang, Kasper S.

AU - Sherker, Averell H.

AU - Sokol, Ronald J.

AU - Bezerra, Jorge A.

AU - Magee, John C.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - chronic liver disease

KW - failure to thrive

KW - sarcopenia

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U2 - 10.1016/j.jpeds.2018.07.002

DO - 10.1016/j.jpeds.2018.07.002

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C2 - 30244988

AN - SCOPUS:85053735283

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

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