Mg. Jeschke et al., Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response, CRIT CARE M, 28(5), 2000, pp. 1578-1584
Objective: Recombinant human growth hormone (rHGH) has been shown to increa
se mortality in adult trauma patients; however, little has been reported on
its side effects in children. The acute phase response has been suggested
to he 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 burn patients.
Design: Prospective, randomized, double-blind study.
Setting: Shriners Hospital for Children.
Patients: Thermally injured pediatric patients, ranging in age from 0.1 to
16 yrs.
Interventions: 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.
Measurements and Main Results: Measurements were patient demographics, inci
dence of sepsis, inhalation injury, mortality, serum constitutive proteins,
acute phase proteins, proinflammatory cytokines and insulin-like growth fa
ctor-I (IGF-l), insulin-like growth factor binding protein (IGFBP)-1, and I
GFBP-3. No differences could be demonstrated in age, gender, burn size, inc
idence in sepsis (20% vs. 26%), inhalation injury (46% vs. 27%), or mortali
ty (8% vs. 7%) between those receiving rHGH or placebo. Serum IGF-l and IGF
BP-3 increased with rHGH treatment, whereas serum IGFBP-1 decreased compare
d with placebo (p < .05), Burned children treated with rHGH required signif
icantly less albumin substitution to maintain normal levels compared with p
lacebo (p < .05). Those receiving rHGH demonstrated a decrease in serum C-r
eactive protein and serum amyloid-A and an increase in serum retinol-bindin
g protein compared with placebo (p < .05). rHGH decreased serum tumor necro
sis factor-alpha and interleukin (IL)-1 beta, whereas no changes were found
for serum IL-1 alpha, IL-6, and IL-10 compared with placebo (p <.05). Free
fatty acids were elevated in burned children who received rHGH (p < .05).
Conclusion: Data indicate that rHGH does not increase mortality. rHGH decre
ased acute phase proteins, tumor necrosis factor-alpha, and IL-1 beta, whic
h is associated with increases in constitutive hepatic proteins and IGF-l.