Use of growth hormone in the treatment of pediatric burns

Abstract

Hypermetabolic response is characterized by a hyperdynamic circulatory response, with increased body temperature; increased oxygen and glucose consumption; increased carbon dioxide production; hyperglycemia (raised blood sugar levels); peripheral insulin resistance; glycogenolysis, proteolysis, and lipolysis (i.e. the breakdown of glycogen, protein, and lipids, respectively); the loss of lean body mass; and muscle and bone wasting. These symptoms can last for 1-2 years after the burn injury. Failure to satisfy overwhelming energy and protein requirements results in multiorgan dysfunction and an increased susceptibility for infection and death. Immunocompromization and delayed wound healing usually result in severe sepsis, which is the most common direct cause of death in these patients. Nevertheless, providing adequate caloric and protein requirements alone was found to be insufficient to attenuate the hypermetabolic response efficiently. Thereby, various pharmacologic modalities to modulate metabolic response have become a corner stone in the management of severely burned patients. Recombinant growth hormone is the most frequently prescribed agent in pediatrics. This review will focus on the metabolic and immune responses to the use of recombinant growth hormone in pediatric burn patients. It will explore what is beyond growth hormone and the role of insulin-like growth factor-1 in modulation of immunity and apoptosis.