ORIGINAL ARTICLES

Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis

K A Bonuck¹, K Freeman², J Henderson³

¹ Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
² Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
³ Department of Community-based Medicine, University of Bristol, Bristol, UK

Karen Bonuck, Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Mazer, Bronx, NY 10461, USA; bonuck{at}montefiore.org

Objective: To determine the effect of adenoidectomy and/or tonsillectomy ("adenotonsillectomy") upon growth and growth biomarkers, in the context of sleep disordered breathing (SDB). SDB in children, primarily due to adenotonsillar hypertrophy, increases the risk of growth failure.

Design: Systematic review and meta-analysis. PubMed, ERIC and Cochrane Reviews databases from January 1980 to November 2007 were searched for studies reporting: pre/post-adenotonsillectomy height and weight changes as percentage increased or decreased, raw data, z scores or centiles, or: IGF-1 and/or IGFBP-3 serum-level changes as z scores or raw data. For anthropometrics, the meta-analysis included studies presenting z scores or centiles.

Setting: Observational studies.

Patients: Otherwise healthy children, not selected for obesity.

Main outcome measures: Pre/post-surgery changes in standardised height and weight, and IGF-1 and IGFBP-3.

Results: Of 211 citations identified, 20 met systematic review criteria. SDB was an enrolment criterion in 13 of the studies, and one of several enrolment criteria in three. Meta-analysis findings for pre/post-surgery changes were: standardised height: 10 studies, 363 total children, pooled standardised mean differences (SMD) = 0.34 (95% CI 0.20 to 0.47); standardised weight: 11 studies, 390 total children, pooled SMD = 0.57 (95% CI 0.44 to 0.70); IGF-1: 7 studies, 177 total children, pooled SMD = 0.53 (95% CI 0.33 to 0.73); IGFBP-3: 7 studies, 177 total children, pooled SMD = 0.59 (95% CI 0.34 to 0.83).

Conclusions: Standardised height and weight, and IGF-1 and IGFBP-3 increased significantly after adenotonsillectomy. Findings suggest that primary care providers and specialists consider SDB secondary to adenotonsillar hypertrophy when screening, treating and referring children with growth failure.

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