Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response.
OBJECTIVE
Recombinant human growth hormone (rHGH) has been shown to increase mortality in adult trauma patients; however, little has been reported on its side effects in children. The acute phase response has been suggested to be a contributing factor to trauma mortality. Therefore, the purpose of this study was to examine the effects of exogenous rHGH on the acute phase response in pediatric bum patients.


METHODS
Prospective, randomized, double-blind study.


METHODS
Shriners Hospital for Children.


METHODS
Thermally injured pediatric patients, ranging in age from 0.1 to 16 yrs.


METHODS
Twenty-eight thermally injured children received either 0.2 mg/kg/day of rHGH or saline (placebo) within 3 days of admission and for at least 25 days.


RESULTS
Measurements were patient demographics, incidence of sepsis, inhalation injury, mortality, serum constitutive proteins, acute phase proteins, proinflammatory cytokines and insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein (IGFBP)-1, and IGFBP-3. No differences could be demonstrated in age, gender, burn size, incidence in sepsis (20% vs. 26%), inhalation injury (46% vs. 27%), or mortality (8% vs. 7%) between those receiving rHGH or placebo. Serum IGF-I and IGFBP-3 increased with rHGH treatment, whereas serum IGFBP-1 decreased compared with placebo (p < .05). Burned children treated with rHGH required significantly less albumin substitution to maintain normal levels compared with placebo (p < .05). Those receiving rHGH demonstrated a decrease in serum C-reactive protein and serum amyloid-A and an increase in serum retinol-binding protein compared with placebo (p < .05). rHGH decreased serum tumor necrosis factor-alpha and interleukin (IL)-1beta, whereas no changes were found for serum IL-1alpha, IL-6, and IL-10 compared with placebo (p < .05). Free fatty acids were elevated in burned children who received rHGH (p < .05).


CONCLUSIONS
Data indicate that rHGH does not increase mortality. rHGH decreased acute phase proteins, tumor necrosis factor-alpha, and IL-1beta, which is associated with increases in constitutive hepatic proteins and IGF-I.
Jeschke
M G
MG
Shriners Hospital for Children and Department of Surgery, University of Texas Medical Branch, Galveston, USA.
Barrow
R E
RE
Herndon
D N
DN
D000209:Acute-Phase Proteins / Q000378:metabolism; D000210:Acute-Phase Reaction / Q000139:chemically induced* / Q000276:immunology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D002056:Burns / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D004311:Double-Blind Method; D005260:Female; D013006:Growth Hormone / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008099:Liver / Q000187:drug effects* / Q000276:immunology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000209:Acute-Phase Proteins; D016207:Cytokines; D013006:Growth Hormone