THE SYSTEMIC STRESS-RESPONSE TO THERMAL-INJURY IN CHILDREN

OBJECTIVE Thermal injury is extremely stressful, but data characterizi ng the endocrine stress response to this injury in children are sparse , The objective of this study was to measure the effects of thermal in jury on the levels of stress hormones in children and to assess the te mporal changes associated with them. PATIENTS Twenty-three children, 1 3 girls and 10 boys aged between 5 months and 12 years 3 months (mean, 2 years 11 months), with burns covering 10-61% of their body surface (mean, 20.5%) were studied during the first 5 days following injury. M EASUREMENTS The levels of arginine vasopressin, angiotensin II, cortis ol, adrenaline, noradrenaline and dopamine were measured in sequential blood samples obtained from thermally injured children on admission a nd at specified time intervals during the 5 days of the investigation. RESULTS At admission the concentrations of all the hormones were high , and varied widely between individual patients, The geometric mean an d 95% confidence intervals of admission hormone levels were as follows : arginine vasopressin 18.3 (8.3-40.7) pmol/l; angiotensin II 122.0(56 .0-266.2) pmol/l; cortisol 650.6 (473.0-895.0) nmol/l; dopamine 1.0 (0 .1-8.0) nmol/l; adrenaline 6.4 (3.2-12.5) nmol/l and noradrenaline 2 3 (1.3-4.3) nmol/l, Although the concentrations of arginine vasopressin and cortisol returned to normal 24 to 36h after admission, the levels of angiotensin II,adrenaline and dopamine fluctuated and remained hig her than normal throughout the study (108 h), CONCLUSIONS Thermal inju ry results in the release of abnormally high levels of stress hormones in children, Although there are similarities between some of the data reported here and those reported in adults, higher levels of adrenali ne and lower levels of noradrenaline than reported in adults suggest i mportant differences too. These differences may need to be taken into account in the management of burn-injured children.