Growth trajectories of children with short bowel syndrome during the first year of teduglutide treatment

Background & aim: Short bowel syndrome (SBS) is the leading cause of pediatric intestinal failure and is frequently associated with impaired growth due to malabsorption and prolonged dependence on parenteral nutrition (PN). Teduglutide (TED), a glucagon-like peptide-2 analogue, promotes intestinal adaptation and may reduce PN requirements. Recent real-world data suggest that baseline nutritional status influences treatment response, but growth trajectories during TED therapy remain poorly characterized. This study aimed to evaluate linear and ponderal growth over the first 12 months of TED treatment, stratified by treatment response and achievement of PN weaning. Methods: Data were drawn from a large European multicenter cohort of children with SBS-associated intestinal failure treated with TED. Response was defined as a >20% reduction in PN volume or calories; PN weaning was defined as full discontinuation of PN within 52 weeks. Weight, height, and BMI were measured every 3 months, and z-scores were calculated using CDC growth charts. Longitudinal changes were compared between responders and non-responders; and between children who achieved PN weaning and responders which were not weaned. Results: Among 104 treated children, 68 were responders and 21 achieved full PN weaning. Responders showed significantly better baseline weight (−1.2 vs – 2.1 p: 0.013) and BMI z-scores (−0.7 vs −1.2 p: 0.021) compared to non-responders and maintained its significantly higher throughout follow-up and until 12 months (−1.2 vs −1.7 p: 0.046; −0.4 vs −1.4 p < 0.001 respectively). Children who achieved PN weaning did not show any significant variation on growth parameters at baseline when compared to non-weaned; during follow-up they showed a significant difference at nine months in weight (−1.6 vs −0.9 p: 0.018) and height z-score (−1.4 vs −0.9 p:0.034) which were non-significant at the end of 12 months follow-up (−1.4 vs −1.3 p: 0.15; −1.8 vs −1.2 p: 0.19). Conclusion: TED treatment was associated with more favourable weight and BMI trajectories compared to non-responders, particularly in responders, who maintained higher z-scores throughout follow-up despite modest within-group changes. However, PN withdrawal appeared to coincide with a period of growth vulnerability, highlighting the need for close nutritional monitoring. These findings support a potentially beneficial role of TED on growth, while emphasizing that PN weaning should be managed cautiously to avoid compromising linear and ponderal growth.