GROWTH-HORMONE TREATMENT IN PEDIATRIC BURNS - A SAFE THERAPEUTIC APPROACH

Objective To determine the safety and efficacy of recombinant human gr owth hormone (rhGH) in the treatment of children who are severely burn ed. Summary Background Data During the last decade, we have used recom binant human growth hormone (rhGH; 0.2 mg/kg/day SQ) to successfully t reat 130 children with more than 40% total body surface area (TBSA) bu rns to enhance wound healing and decrease protein loss, A significant increase in the mortality of adult patients in the intensive care unit who were given rhGH has recently been reported In two large European trials which questions the therapeutic safety of rhGH. Methods The rec ords of 263 children who were burned were reviewed. Patients receiving either rhGH at 0.2 mg/kg/day subcutaneously as part of a randomized c linical trial (n = 48) or therapeutically (n = 82) were compared with randomized placebo-administered controls (n = 54), contiguous matched controls (n = 48), and matched patients admitted after August 1997, af ter which no patients were treated with rhGH (n = 31). Morbidity and m ortality, which might be altered by rhGH therapy, were considered with specific attention to organ function or failure, infection, hemodynam ics, and calcium, phosphorous, and albumin balance. Results A 2% morta lity was observed in both rhGH and saline placebo groups in the contro lled studies, with no differences in septic complications, organ dysfu nction, or heart rate pressure product identified. in addition, no dif ference in mortality could be shown for those given rhGH therapeutical ly versus their controls. No patient deaths were attributed to rhGH in autopsies reviewed by observers blinded to treatment. Hyper glycemic episodes and exogenous insulin requirements were higher among rhGH rec ipients, whereas exogenous albumin requirements and the development of hypocalcemia was reduced. Conclusions Data indicate that rhGH used in the treatment of children who were severely burned is safe and effica cious.