O-009 Effects of Disease Activity and anti-TNF Therapy Upon Skeletal Maturation and Linear Growth in a Prospective Pediatric IBD Cohort
Bibliographic record
Abstract
Linear growth impairment is a well recognized feature of Crohn’s Disease (CD), although defining it is challenging. Its presence at diagnosis can be indicative of the duration of unrecognized disease, whilst patterns post-diagnosis are reflective of treatment and treatment efficacy. Over the past decade, the awareness of IBD in the pediatric community has improved, as have the treatment options. AIM: (1) To examine the utility of Mid-parental Height and Skeletal Maturity in the assessment of growth impairment; (2) to review pre-and post diagnostic linear growth patterns in pre-pubertal children diagnosed with CD during the era of anti-TNF therapy. All patients diagnosed with IBD who were Tanner Stage I at diagnosis and would be regularly followed at the recruiting centre were eligible for this study. Patients were recruited sequentially from Sept 2007 to Sept 2009. Height potential was calculated based on the established “mid-parental-height” formula. Left Wrist Radiographs were obtained on all patients at baseline and after 2 years follow-up, and skeletal maturity estimated by a single experienced Endocrinologist. Linear growth, medication exposure and disease activity were collected at regular intervals for a minimum of 3 years. Height Z-scores were calculated using the CDC reference data. Two hundred eight patients (64% Male, 70% CD) were recruited. Predicted Ht-Z scores based on mid-parental height data were normally distributed (mean −0.02, SD 0.84). However, the group’s true mean Ht-Z score at diagnosis was reduced (mean −0.45, SD 1.0) as was their skeletal maturity (mean deficit 0.6 years, SD 1.5 years). Bone age delay correlated well with Ht-Z score deficit (r = 0.6, P < 0.001). Growth deficits were greater in CD than UC patients (Mean Ht-z deficit −0.55 versus −0.14, P = 0.012). In CD patients, disease activity during 2 years of follow-up, substantially impacted ongoing linear growth and skeletal maturity (none/minimal disease activity: median delta bone age 21 months; >minimal disease activity: median delta bone age 13 months; P = 0.013). Patients receiving anti-TNF therapy within the first year of diagnosis experienced a substantial increase in Ht-z score compared to patients who did not receive such therapy (Mean Delta Ht-Z score 0.31 versus 0.09, P = 0.009). Linear growth impairment remains a diagnostic feature of children with CD, although the degree of impairment in the recent decade appears less than in prior decades. Mid-parental heights appear a robust method of predicting an individual patient’s growth potential, and relative changes in skeletal maturity another method of confirming ongoing status. Effective disease control remains paramount in the management of children with CD and impaired linear growth. (This research was supported by a CCFA Senior Award, PI: Dr LA Denson).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".