Gender differences in pediatric burn patients: does it make a difference?
OBJECTIVE
There is evidence that females have a better outcome in intensive care units (ICUs) when compared with males. The aim of the present study was to compare hospital course and physiologic markers between severely burned pediatric females and males.


BACKGROUND
One-hundred eighty-nine children sustaining a >or=40% total body surface area burn were divided into females (n = 76) and males (n = 113).


METHODS
: Patient demographics, clinical parameters, and mortality were noted. Muscle protein synthesis was determined by stable isotope technique. Resting energy expenditure (REE) was measured by indirect calorimetry and body composition by dual x-ray absorptiometry. Serum hormones, proteins, and cytokines were determined. Cardiac function and liver size were determined by repeated ultrasound measurements.


RESULTS
There were no significant differences between females and males for mortality, demographics, burn size, nutritional intake, or concomitant injuries. ICU stay was in females: 29+/-3 days whereas the stay in males was 38+/-3 days, P < 0.05. Females had a significant attenuated loss in muscle protein net balance (females: -0.028+/-0.001% vs. males: -0.05+/-0.007%) and an increase in lean body mass (Delta females: 5+/-4% vs. Delta males: -1+/-3%), P < 0.05. Percent-predicted REE was significantly decreased in females compared with males, P < 0.05. Systemic inflammatory markers and stress hormone levels were significantly decreased in females, P < 0.05. Cardiac and liver dysfunction were significantly attenuated in females compared with males, P < 0.05.


CONCLUSIONS
Female burned patients exert an attenuated inflammatory and hypermetabolic response compared with males. This decrease is reflected in improved muscle protein net balance and preservation of lean body mass, which are associated with shortened hospital stay.
Jeschke
Marc G
MG
Shriners Hospitals for Children, Galveston, Texas 77550, USA. majeschk@utmb.edu
Mlcak
Ronald P
RP
Finnerty
Celeste C
CC
Norbury
William B
WB
Przkora
Rene
R
Kulp
Gabriela A
GA
Gauglitz
Gerd G
GG
Zhang
Xiao-Jun
XJ
Herndon
David N
DN
D000293:Adolescent; D001823:Body Composition; D002056:Burns / Q000453:epidemiology* / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness; D016207:Cytokines / Q000097:blood; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D007223:Infant; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007902:Length of Stay; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D009124:Muscle Proteins / Q000378:metabolism; D012737:Sex Factors; D014463:Ultrasonography; D015431:Weight Loss
D016207:Cytokines; D009124:Muscle Proteins; D007334:Insulin-Like Growth Factor I; D006854:Hydrocortisone