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Growth and Growth Biomarker Changes After Adenotonsillectomy: Systematic Review and Meta-Analysis
  1. Karen Bonuck (kbonuck{at}
  1. Albert Einstein College of Medicine, United States
    1. Katherine Freeman (kfreeman{at}
    1. Montefiore Medical Center, United States
      1. John Henderson
      1. University of Bristol, United Kingdom


        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 risk of growth failure.

        Design: Systematic review and meta-analysis. PubMed, ERIC, and Cochrane Reviews databases from January 1980 ¡VNovember 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. Use of SDB criteria in sample selection is identified. 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 standardized height and weight, and IGF-1 and IGFBP-3.

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

        Conclusions: Standardized 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 AT hypertrophy when screening, treating and referring children with growth failure.

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