Long-term propranolol use in severely burned pediatric patients: a randomized controlled study.
OBJECTIVE
To determine the safety and efficacy of propranolol given for 1 year on cardiac function, resting energy expenditure, and body composition in a prospective, randomized, single-center, controlled study in pediatric patients with large burns.


BACKGROUND
Severe burns trigger a hypermetabolic response that persists for up to 2 years postburn. Propranolol given for 1 month postburn blunts this response. Whether propranolol administration for 1 year after injury provides a continued benefit is currently unclear.


METHODS
One-hundred seventy-nine pediatric patients with more than 30% total body surface area burns were randomized to control (n = 89) or 4 mg/kg/d propranolol (n = 90) for 12 months postburn. Changes in resting energy expenditure, cardiac function, and body composition were measured acutely at 3, 6, 9, and 12 months postburn. Statistical analyses included techniques that adjusted for non-normality, repeated-measures, and regression analyses. P < 0.05 was considered significant.


RESULTS
Long-term propranolol treatment significantly reduced the percentage of the predicted heart rate and percentage of the predicted resting energy expenditure, decreased accumulation of central mass and central fat, prevented bone loss, and improved lean body mass accretion. There were very few adverse effects from the dose of propranolol used.


CONCLUSIONS
Propranolol treatment for 12 months after thermal injury, ameliorates the hyperdynamic, hypermetabolic, hypercatabolic, and osteopenic responses in pediatric patients. This study is registered at clinicaltrials.gov: NCT00675714.
Shriners Hospitals for Children-Galveston, Galveston, TX 77550, USA. dherndon@utmb.edu
David N
DN
Herndon
Noe A
NA
Rodriguez
Eva C
EC
Diaz
Sachin
S
Hegde
Kristofer
K
Jennings
Ronald P
RP
Mlcak
Jaipreet S
JS
Suri
Jong O
JO
Lee
Felicia N
FN
Williams
Walter
W
Meyer
Oscar E
OE
Suman
Robert E
RE
Barrow
Marc G
MG
Jeschke
Celeste C
CC
Finnerty
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001823:Body Composition / Q000187:drug effects; D002056:Burns / Q000188:drug therapy* / Q000401:mortality; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004734:Energy Metabolism / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011433:Propranolol