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

• Type of Material: Article
• Authors: Estella M Alonso, Northwestern University; Wen Ye, University of Michigan; Kieran Hawthorne, Arbor Research Collaborative for Health; Veena Venkat, Children's Hospital Pittsburgh; Kathleen M Loomes, Childrens Hospital of Philadelphia; Cara L Mack, University of Colorado; Paula M Hertel, Baylor College of Medicine; Saul Karpen, Emory University; Nanda Kerkar, University of Southern California; Jean P Molleston, Indiana University; Karen F Murray, University of Washington; Rene Romero, Emory University; Philip Rosenthal, University of California, San Francisco; Kathleen B Schwarz, Johns Hopkins University; Benjamin L Shneider, Baylor College of Medicine; Frederick J Suchy, Children's Hospital Colorado; Yumirle P Turmelle, Washington University; Kasper S Wang, University of Southern California; Averell H Sherker, National Institute of Diabetes and Digestive and Kidney Diseases; Ronald J Sokol, University of Colorado; Jorge A Bezerra, Cincinnati Children's Hospital Medical Center; John C Magee, University of Michigan
• Language: English
• Date: 2018-11-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2018.07.002
• Title of Journal or Parent Work: Journal of Pediatrics
• ISSN: 0022-3476
• Volume: 202
• Start Page: 179
• End Page: +
• Grant/Funding Information: This work was supported by U01 grants from the National Institute of Diabetes, 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].
• Keywords: FRAILTY; HEPATOPORTOENTEROSTOMY; TRANSPLANTATION; Life Sciences & Biomedicine; SARCOPENIA; UNITED-STATES; TIME; OUTCOMES; CHILDREN; FAILURE; Science & Technology; Pediatrics; STAGE LIVER-DISEASE
• Research Categories: Health Sciences, Medicine and Surgery

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.