Table 1 Twenty studies that report changes in either height, weight, IGF-1 or IGFBP-3 pre/post adenotonsillectomy surgery in children
Study author, year, countryNo. with pre and post dataAge, pre-T&AGrowth failure reported at baseline†Source of sampleSDB in sample?Follow-up, post-T&AChange in height and weight before and after T&A (reference group)Change in IGF-1 and IGFBP-3 before and after T&A
Ahlqvist, 1992, Sweden63851.8–15.8 years, median 6.6 yearsNoENT clinicSome: snoring and apnoea among inclusion criteriaWithin 12 months for 75%Ht: excess gain vs expected
Wt: excess gain vs expected (Swedish growth charts)
Aydogan, 2007, Turkey64384–10 years, mean 6.7 yearsNoENT clinicSome: 30/38 snored; 16/38 disturbed sleep by questionnaire12–18 monthsHt: z score = −0.03IGF-1 z score = 0.06
Wt: z score = 0.44IGFBP-3 z score = 0.58
(Turkish growth charts)(used SDSs normed for age)
Bar, 1999, Israel65131.6–10.8 years, mean 6.0 yearsNoSleep centreAll: OSAS by history, exam and sleep monitoring18 months (wt and ht), 5 months (IGF data)Ht: insufficient data‡IGF-1 SMD = 0.85 ng/ml
Wt: z score = 0.85IGF-BP3, no increase stated
(US growth charts)
Brouillette, 1982, USA6622Mean 14 months,Yes: 6/22 (weight)Sleep centreAll: OSAS by history, exam, ECG and chest/ upper airway radiographySurgery for OSAS: 11 T&A/10 other surgery; unspecified follow-up periodHt: not assessed
SD 12 monthsWt: underweight resolved in 6/22
(US growth charts)
Barr, 1988, Scotland67823.1–15.1 yearsNoENT clinicNot specified12 monthsHt: not assessed
Wt: 20% increased over expected
(unspecified reference group)
Camilleri,1122.9–10.8 years,NoENT clinicNot specified12 monthsHt: no %ile
1995,mean 6.1 yearsincrease
Scotland68Wt: increased velocity (Tanner and Whitehouse velocity)
Conlon, 1997, Ireland69552–14 years, mean 7 yearsNoENT clinicNot specified18 months (mean)Ht: not assessed
Wt: increase 12% vs expected (Irish growth charts)
Ersoy, 2005, Turkey70283–10 years, mean 6.2 yearsNoENT clinicAll: snoring, apnoea and/or difficulty breathing by exam and questionnaire12 monthsHt: z score = 0.41 Wt: z score = 0.62 (Turkish growth charts)IGF-1 SMD =  0.86 ng/ml IGFBP-3 SMD =  0.38 ng/ml
Lind, 1982, Sweden71142.8–7.6 years, mean 4.8 yearsYes: Wt z score<0 Ht z score<0ENT clinicAll: OSAS by exam and day+night capnography10–42 monthsHt: z score = 1.41 Wt: z score = 1.59 (Swedish growth charts)
Marcus, 1994, USA72142–6 years, mean 4 yearsYes: Wt z score<0Sleep centreAll: OSAS by polysomnography10 weeks (mean)Ht: not assessed Wt: z score = 0.90 (US growth charts as reference)
Nieminen, 2002, Finland73194.5–6.6 years, mean 5.6 yearsNoENT clinicAll: OSAS per polysomnography6 monthsHt: z score = 0.38 Wt: insufficient data‡ (Finnish growth charts)IGF-1 SMD =  0.83 nmol/l IGFBP-3 SMD =  0.90 ng/l
Nuyens,† 1999, Switzerland7465ENT clinicSome: obstructive symptoms (snoring, apnoeas ↓90% after T&A)6–12 monthsHt-for-age: 8 increased %ile
Wt-for-ht: 25 increased %iles
(reference data NA)
Roemmich, 2006, USA75546–12 years,NoStudy of SDB and AHAll: OSAS per polysomnography and report of snoring frequency6−27.4 monthsHt: z score = −0.01§
mean 7.8 yearsWt: z score = 0.36§
(US growth charts as reference)
Selimoglu, 2003, Turkey76294–12 years, mean 7.3 yearsYes: for 3/29, wt z score<−0.2ENT clinicAll: by obstructive adenotonsillar hypertrophy on Brodsky scale6 monthsHt: z score = 0.68 Wt: z score = 0.68 (Turkish growth charts)IGF-1 = 0.68 ng/ml IGFBP-3, reported as not increased
ht z score <−0.2
Shatz, 2004, Israel77245–12 months,Yes: for 19/24, wt and ht <3rd %ileENT clinicAll: SDB symptoms, hypertrophy and OSAS by polysomnography4–18 months“Failure to thrive” resolved in 10/24
mean 10 months
Soultan, 1999, USA78451.4–10.3 years, mean 4.9 yearsYes: for 3/45, wt <5th %ileENT clinicAll: OSAS by clinical diagnosis+tonsillar hypertrophy6 months−3 yearsHt: z score = 0.53
Wt: z score = 0.53 (US growth charts)
Stradling, 1990, UK79612–14 years, mean 4.7 yearsNoENT clinicAll: by report of snoring6 monthsHt: z score = 0.29§ Wt: z score = 0.45§ (Tanner and Whitehouse)
Vontetsianos, 2005, Greece8057Mean 5 yearsNoENT clinicNot specified6–13 monthsHt: z score = 0.53IGF-1 SMD = 0.41 IU/l (for 18/57)
IGFBP-3, no data given
Williams, 1991, USA8118 ht, 37 wt (41 at baseline)6–36 monthsYes: wt 19/41 <5th %ile; ht 15/34 <5th %ileENT inpatientsAll: obstructive symptoms by record review for 37/41 total11.6 months (mean)Ht: z score = 0.39§
Wt: z score = 0.97§ (Ross curves, age and sex adjusted)
Yilmaz, 2002, Turkey82324–8 yearsNoENT clinicAll: obstructive symptoms+tonsillar hypertrophy5.8 months (mean)Ht: not assessed Wt: not assessedIGF-1 SMD =  0.64 ng/ml IGFBP-3 SMD =  0.64 ng/ml
  • *Greater than expected proportion of children identified with growth failure, generally <5th %ile in age and sex-adjusted weight or height before surgery.

  • †Data obtained from abstract of foreign language publication; complete publication not reviewed.

  • ‡For Bar, although height SDS data were presented, no p value was given, thus the SD of the difference could not be determined. For Nieminen, weight-for-height percentage values were presented which exceeded 100% and are thus implausible.

  • §z Scores computed from standardised percentiles. For Williams, percentiles obtained from raw data in figures.

  • Studies shown here for which a z score was not given or could not be calculated were not included in meta-analyses. AH, adenotonsillar hypertrophy; ENT, ear nose and throat; ht, height; IGF-1, insulin-like growth factor-1; IGFBP-3, IGF-binding protein 3; NA, not available; OSAS, obstructive sleep apnea syndrome; SDS, standard deviation score; T&A, adenotonsillectomy; – indicates not assessed; wt, weight.