Burn Injuries In Children Research Articles

Changes in fat distribution in children following severe burn injury.

Children with severe cutaneous burn injury show persistent metabolic abnormalities, including inflammation and insulin resistance. Such abnormalities could potentially increase their future risk for developing type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). This could be related to changes in body composition and fat distribution. We studied body composition, fat distribution, and inflammatory cytokines changes in children with severe burn injury up to 6 months from discharge. Sixty-two boys and 35 girls (burn ≥30% of total body surface area) were included. We found a decrease in total body fat and subcutaneous peripheral fat at 6 months (6% and 2%, respectively; P<0.05 each). An inverse correlation between the decrease in peripheral fat content at 6 months and the extent of burn injury (r=-041, P=0.02) was also observed. In addition, there was a 12% increase in serum tumor necrosis factor-α (TNF-α) (P=0.01 vs. discharge) and 9% decrease in serum interleukin-10 (IL-10) (P<0.0001 vs. discharge) over 6 months after burn. Severe burn injury in children is associated with changes in body fat content and distribution up to 6 months from hospital discharge. These changes, accompanied by persisting systemic inflammation, could possibly mediate the observed persistence of insulin resistance, predisposing burn patients to the development of T2DM and CVD.

Parents' Perceptions of Adaptation and Family Life After Burn Injuries in Children

The aim of this study was to explore parents' experiences after their child's burn injury, focusing on how the burn had influenced family life and child adjustment. Six semi-structured interviews with parents of children treated at burn centers 2 to 7 years previously revealed the theme, "Feeling quite alone in striving to regain family wellbeing". Identification of difficulties perceived by the parents during rehabilitation and up until the present is useful when developing pediatric burn care and support for parents of children with burns.

Socioeconomic impact of children's burns—A pilot study

ObjectiveThis pilot study aimed to gain empirical data on the social and economic impacts of child burns on children and parents, in the context of the outpatient setting. MethodA questionnaire was completed by 52 parents of paediatric patients attending the burns outpatient department at Queen Victoria Hospital (QVH), East Grinstead, for at least the third time. Children's medical notes were used to extract demographic and medical data. Quantitative data was analyzed statistically and qualitative data was analyzed manually using content analysis. ResultsThe financial burden related to the injury posed the greatest impact on parents, and was mainly associated with making the journey to the hospital, with lower income households being most affected. Self-employed parents and those who had to attend more than 6 hospital appointments also ran into difficulties. On the whole, there was not a considerable social impact on the burn-injured child, which may reflect the minor nature of burns in this study (mean depth partial thickness, median TBSA 1.0%). ConclusionParents were shown to perceive a greater impact from their child's burn injury than their child. Certain groups of parents were identified as requiring additional support following the burn injury.

Systemic factors associated with adipose tissue remodeling after severe burn injury in children (1160.2)

The chronic adrenergic stress response to severe burn injury a causes plethora of metabolic abnormalities. However, the impact of burn injury on adipose tissue (AT) metabolism remains largely unknown. Here, we studied the effect of severe burn injury on systemic biomarkers thought to be involved in AT remodeling (i.e. White‐to‐brown transdifferentiation).Ten severely burned children (age 12±4 years; % total burn surface area 49±20) and ten healthy children (age 12±5 years) participated in this study. Hormones levels were measured by luminex multiplex magnetic assay kit and ELISA kit in plasma samples obtained in the fasted state (2‐4 weeks post injury in burned patients).Plasma fibroblast growth factor 21 (634 vs 40 pg/ml, (p=0.07), leptin (9 vs 1.2 ng/ml; p=0.055), interleukin ‐ 6 (68 vs 4.8 pg/ml; p=0.03) and amylin (65 vs 24 ng/ml, p=0.06) were all increased systemically in burn patients vs. healthy subjects. Irisin also showed a trend to be increased in burn patients (116 vs 83 ng/ml, p=0.24), however this was not statistically different. These findings suggest that severe chronic inflammatory stress alters the systemic hormonal profile of burn patients in a similar manner to that observed during adrenergic stimulation in rodents that has been shown to result in white‐to‐brown transdifferentiation.Grant Funding Source: NIH (P50‐GM60338, R01‐GM05668) and SHC (84090, 84080, 71008 and 71006) g

Prospective Evaluation of Parent Distress Following Pediatric Burns and Identification of Risk Factors for Young Child and Parent Posttraumatic Stress Disorder

Early childhood is a high-risk time for exposure to potentially traumatic medical events. We have previously reported that 10% of young children continue to have posttraumatic stress disorder (PTSD) 6 months after burn injury. This study aimed to 1) document the prevalence and prospective change in parental psychological distress over 6 months following their child's burn injury and 2) identify risk factors for posttraumatic stress symptoms (PTSS) in young children and their parents. Participants were 120 parents of 1-6-year-old children with unintentional burn injuries. Data were collected within 2 weeks, 1 month, and 6 months of burn injury using developmentally sensitive diagnostic interviews and questionnaires. Within the first month, ∼ 25% of parents had a probable PTSD diagnosis, and moderate to extremely severe levels of depression, anxiety, and stress. Distress levels decreased significantly over time; however, 5% of parents still had probable PTSD at 6 months. Hierarchical multiple regression and path analyses indicated that parent posttraumatic stress reactions contributed significantly to the development and maintenance of child PTSS. Other risk factors for child PTSS included premorbid emotional and behavioral difficulties and larger burn size. Risk factors identified for parent PTSS included prior trauma history, acute distress, greater number of child invasive procedures, guilt, and child PTSS. The findings from this study suggest that parents' responses to a traumatic event may play a particularly important role in a young child's psychological recovery. However, further research is needed to confirm the direction of the relationship between child and parent distress. This study identified variables that could be incorporated into screening tools or targeted by early intervention protocols to prevent the development of persistent child and parent PTSS following medical trauma.

The effectiveness of trace element supplementation following severe burn injury: A systematic review protocol

Review question/objective The objective of this review is to assess the effectiveness of trace element supplementation on clinically meaningful outcomes following severe burn injury in children and adults. More specifically, the objectives are to assess the effectiveness of selenium, copper and zinc supplementation on mortality, length of intensive care unit (ICU) hospital stay, wound healing and infection rates (wound and nosocomial) in patients who have sustained a severe burn injury. Inclusion criteria Types of participation This review will consider studies that include children (2-18 years of age) and adults (≥ 18 years of age) who have sustained a severe burn injury (defined as burn injury ≥ 10% Total Body Surface Area (TBSA) in children and ≥ 15% TBSA in adults) and been admitted to an ICU, Burns ICU (BICU), or burns unit for surgical management of their injury. Studies that include patients with significant multi-trauma in addition to burn injury will be excluded. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate enteral or parenteral supplementation of selenium, copper and zinc, either alone or combined and compared to placebo or regular treatment. Intervention and comparison groups will have received standard nutrition intervention including enteral or parenteral nutrition and multi-vitamin supplements. Studies that include trace element supplementation in combination with other predefined nutrient supplementations will be considered for inclusion. Types of outcomes This review will consider studies that include the following outcome measures: mortality; length of ICU/ hospital stay; rate of wound healing (time to first donor site healing or time to wound closure); complications (e.g. wound infection, hospital acquired pneumonia). Secondary outcome measures: tissue (measured from skin biopsies) and plasma (measured via blood sampling) selenium, copper and zinc levels.

Paediatric burns: From the voice of the child

IntroductionDespite burns being common in children, research into the psychological experience and trauma remains limited. Improvements in the professional understanding of children's experiences will assist in improving holistic care. PurposeThis study uses phenomenology, a qualitative methodology to explore the psychological experiences following a burn injury in children. MethodsIn-depth interviews were conducted six months after burn with 12 (six girls and six boys) children who underwent surgery for a burn. The children were aged eight to 15 years. The interview examined the overall experience of children and included probing questions exploring participants’ perceptions, thoughts and feelings. Transcripts were analysed according to the seven-step Coliazzi method. Relationships between themes were explored to identify core concepts. ResultsThe findings demonstrated that trauma was central to the burn experience and comprised two phases: the burn trauma and the recovery trauma. Six themes emerged as a result of this experience: ongoing recurrent trauma; returning to normal activities; behavioural changes; scarring-the permanent reminder; family and adaptation. ConclusionThis research has clinical implications as its findings can be used to inform clinical care at all stages of the burn journey. These research conclusions could be used to develop comprehensive information and support management plans for children. This would complement and support the surgical and medical treatment plan, providing direction for comprehensive service delivery and improved psychosocial outcomes in children.

Initial Assessment and Management of Thermal Burn Injuries in Children

1. Ramin Jamshidi, MD* 2. Thomas T. Sato, MD† 1. *The Pediatric Surgeons of Phoenix, Phoenix, AZ. 2. †Division of Pediatric Surgery, Children’s Specialty Group, Children’s Hospital of Wisconsin, and The Medical College of Wisconsin, Milwaukee, WI. Burns are a frequent cause of injury in children and adolescents. Clinicians should be familiar with initial assessment and management of burns and be capable of identifying burn injuries appropriate for referral to a regional burn center. After reading this article, readers should be able to: 1. List 3 types of burn injuries. 2. Describe the initial evaluation of a burned child in terms of burn depth, size, and associated injuries or medical conditions. 3. Describe appropriate burns for outpatient management. 4. Estimate initial fluid resuscitation requirements for the first 24 hours in children with large (>25% total body surface area) partial-thickness burns. 5. Describe 2 methods of dressing management for a 5% total body surface area partial-thickness burn. 6. Recognize indications for transfer of a burned child to a regional burn center. Death from fires and burn injuries is the third leading cause of fatal home injury and the third leading cause of unintentional death in children younger than 14 years in the United States. (1) In 2009, the Centers for Disease Control and Prevention estimated 437 deaths and 120,761 nonfatal burn injuries in children age 0 to 19 years. (2) Although hospitalization rates for children with burns appear to be decreasing in the past decade, annual cost estimates of approximately 10,000 inpatient hospitalizations for pediatric burn care exceeded $211 million in 2000. (3) Although it is difficult to estimate the global incidence rate, morbidity, and mortality of burn injuries, it is clear that burns are a major cause of injury in both developed and developing countries. (4) Burns are one of the most physiologically and psychologically stressful injuries that occur in children and adults. Given the …

Initial Assessment and Management of Thermal Burn Injuries in Children

Initial Assessment and Management of Thermal Burn Injuries in Children

Burn Injuries in Children and the Use of Biological Dressings

Burns represent a significant cause of morbidity and mortality in children. In this article, a case discussion will serve as a platform for discussing the evaluation and treatment of burns in children. Use of various burn dressings such as hydrocolloids, polyurethane films, hydrogels, biosynthetic skin dressing, and biological dressings will be discussed.

Stigma perspective of siblings of children with a major childhood burn injury

To understand the stigma perspective of siblings of children with major burn injury. A mixed method, qualitative-dominant study was conducted. The life story method was used for the qualitative portion. Only narratives from those family members describing the sibling's appearance change were used (N = 18 participants). Stigma experienced by siblings was first described by parents or noninjured siblings; they described how the sibling with changed appearance was stared at, ridiculed, or teased when they entered a new social situation. Only when specifically asked did the children with burn injury talk about their problems, saying, "This always happens when I go somewhere new." Children with changed appearance focused on normalizing their lives in a positive way. Oftentimes, it was a parent or noninjured sibling who would describe manifestations of stigma and ways they tried to protect the child with burn injury.

Self-Perceptions of Young Adults Who Survived Severe Childhood Burn Injury

The transition of pediatric burn survivors into adulthood is accompanied by a reformulation of their self-concept. To anticipate the need for and guide development of appropriate psychosocial interventions, this study examines how young adults who were burned as children perceive themselves and how this perception might affect their self-esteem. Eighty-two young adult burn survivors (45 male, 37 female) were assessed using the Tennessee Self-Concept Scale, 2nd edition (TSCS2) to determine how the participants perceive themselves and their interaction with society. To gain insight into the possible effects of these self-concept scores, relationships were analyzed between self-concept, a behavioral assessment (Young Adult Self-Report [YASR]), and a psychiatric symptom assessment (Structured Clinical Interview for DSM-IV Axis I Disorders [SCID I]). This group of burn survivors scored significantly lower in self-concepts, reflected in TSCS2 subscale scores of physical function, appearance, and sexuality, moral conduct, personal values, academics and work, and identity, than did the reference population. Pearson correlation coefficients showed that as moral, personal, family, and social aspects of self-concept decreased, clinical problems endorsed on the YASR subscales increased, including anxiety, somatic, attention, intrusive, and aggressive. Persons with lower self-concept scores on the TSCS2 personal, family, and social scales were more withdrawn on the YASR. Similarly, those with lower TSCS2 scores on the personal and family scales endorsed significantly more thought problems on the YASR. TSCS2 total self-concept, personal, and all of the supplementary scale scores were significantly lower for the group with an affective disorder. Those whose SCID I scores were consistent with a current anxiety disorder had significantly lower scores for the TSCS2 total self-concept and personal. Lower self-concept was associated with endorsement of SCID symptoms. In summary, the significantly lower self-concept scores on the TSCS2 physical scale are consistent with the physical disfigurement and handicaps common with major burn injuries, and a strong indication of this group's perception of the first impression made when interacting with others. The survivors seem to feel worthwhile within the contexts of family and friends. Although the major limitation of this study using the TSCS2 is the lack of a matched reference population to compare the burn survivors, the TSCS2 does help in gaining insight into the self-esteem issues of the burn survivor population.

Design of a cross-sectional study on physical fitness and physical activity in children and adolescents after burn injury

BackgroundBurn injuries have a major impact on the patient’s physical and psychological functioning. The consequences can, especially in pediatric burns, persist long after the injury. A decrease in physical fitness seems logical as people survive burn injuries after an often extensive period of decreased activity and an increased demand of proteins leading to catabolism, especially of muscle mass. However, knowledge on the possibly affected levels of physical fitness in children and adolescents after burn injury is limited and pertains only to children with major burns. The current multidimensional study aims to determine the level of physical fitness, the level of physical activity, health-related quality of life and perceived fatigue in children after a burn injury. Furthermore, interrelations between those levels will be explored, as well as associations with burn characteristics.Methods/designChildren and adolescents in the age range of 6 up to and including 18 years are invited to participate in this cross-sectional descriptive study if they have been admitted to one of the three Dutch burn centers between 6 months and 5 years ago with a burn injury involving at least 10% of the total body surface area and/or were hospitalized ≥ 6 weeks. Physical fitness assessments will take place in a mobile exercise lab. Quantitative measures of cardiorespiratory endurance, muscular strength, body composition and flexibility will be obtained. Outcomes will be compared with Dutch reference values. Physical activity, health-related quality of life and fatigue will be assessed using accelerometry and age-specific questionnaires.DiscussionThe findings of the current study will contribute to a better understanding of the long-term consequences of burn injury in children and adolescents after burns. The results can guide rehabilitation to facilitate a timely and optimal physical recovery.Trial registrationThe study is registered in the National Academic Research and Collaborations Information System of the Netherlands (OND1348800).

EXPERIENCE FROM COMMUNITY BASED CHILDHOOD BURN PREVENTION PROGRAMME IN BANGLADESH: IMPLICATION FOR LOW RESOURCE SETTING

A comprehensive community-based burn prevention framework was developed for rural Bangladesh taking into consideration the magnitude, consequences of burns, risk factors of childhood burn, health seeking behaviour of parents after...

The effect of family characteristics on the recovery of burn injuries in children

Interactions between family members and characteristics of family life and function may affect a child's recovery from burn injury. We prospectively examined the relationship between family characteristics and physical and psychosocial recovery from burns. The families of 399 burned children aged 5 years to 18 years admitted to one of four Shriners Hospitals for Children for management of acute burns completed the Family Environment Scale within 7 days of admission and then the American Burn Association/Shriners Hospitals for Children Burn Outcome Questionnaire (BOQ) at baseline, 3, 6, 12, 18, 24, 36, and 48 months. Generalized estimating equations with random effects for the time since burn were used to track recovery of the BOQ patient-centered domains associated with baseline family characteristics during the course of the study. The children had a mean age of 11 years and burn size of 32% total body surface area burned. Higher Family Environment Scale scores in cohesion, independence, organization, and active recreational orientation were associated with significantly better rates of recovery in multiple BOQ domains of health-related quality of life. Higher scores in conflict and achievement orientation predicted statistically significant impaired recovery. Higher expressiveness predicted greater difficulty with school reentry. Family characteristics affect the recovery of children after serious burns. Some of these may be amenable to focused anticipatory family interventions to help optimize outcomes. In particular, those characteristics that impair school reentry should be targeted.

Progress in Understanding the Calcium and Vitamin D Endocrinology Following Burn Injury in Children

: This review covers the progress made by our group over the past two decades in understanding the effects of severe burn injuries on the endocrine system, especially in relation to calcium and vitamin D metabolism.We examine the phenomena of transient growth hormone deficiency and the dose-dependent effects of recombinant human growth hormone on bone and muscle mass. We move on to discuss the occurrence of post-burn secondary hypoparathyroidism caused by the up-regulation of the parathyroid calcium-sensing receptor, and finally, we discuss vitamin D status, the progressive nature of vitamin D deficiency post-burn, the causes of the progressive deficiency, and what must be done to prevent it.These conditions taken together, while not primarily responsible for post-burn bone loss, may impair the recovery of normal bone density and leave, especially younger populations of victims, vulnerable to a reduction in peak bone mass with subsequent elevated risk of developing osteoporosis as adults. Implication for health policy/practice/research/medical education:This article reviews the endocrine changes that occur as a result of burn injury and provides a basis for understanding these changes in the context of all the changes wrought by burn injury. It also provides a means to study possible measures to prevent and treat these abnormal changes. Please cite this paper as:Klein GL. Progress in Understanding the Calcium and Vitamin D Endocrinology Following Burn Injury in Children. Int J Endocrinol Metab. 2012;10(1): 435-9. DOI: 10.5812/ijem.2685 Copyright © 2012 Kowsar M. P. Co. All rights reserved.

Friction Burns in Children

Laser Doppler imaging (LDI) has been increasingly used to predict pediatric burn wound outcome. A majority of these wounds are scald, contact, or flame burns. No study has specifically evaluated the use of LDI in pediatric friction burns. Our objective was to critically evaluate LDI assessment of pediatric friction burns to determine its predictive value with this mechanism of injury. We conducted a retrospective review of all LDI scans performed on pediatric friction burns during a 2-year period. We identified 36 patients with a mean age of 3.6 years (range, 19 months to 15 years). LDI accurately predicted burn wound outcome in 23 (64%) cases. In 13 cases, LDI did not correctly predict burn wound outcome. Eight were expected to heal within 14 days, but six of those eight took an average of 20.3 days to heal (range, 18-29 days), and the other two required skin grafting. Of the remaining five incorrect predictions, four were caused by an inability to correlate the flux scan with the clinical appearance of the burn, and one was thought to take more than 21 days to heal but healed within this period. Our data suggest that LDI appears to be a less reliable tool in predicting the outcome of friction burns when compared to other mechanisms of burn injury in children. This may reflect the physical differences in the mechanism of friction burns as opposed to other forms of thermal injury.

Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania.

BackgroundBurn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome.Methods A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0.ResultsA total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001).ConclusionChildhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced.

Child burn injury in Dar es Salaam, Tanzania: results from a community survey

The objective of this study was to identify the incidence of burn injuries among children in a sub-Saharan urban area and describe contributing factors in the home environment. A cross-sectional household survey was conducted in Dar es Salaam, Tanzania between 8 and 22 July 2009. Demographic characteristics of participants were reported using descriptive statistics. Bivariate analyses using Pearson's chi-square tests for categorical variables were used to explore possible associations. Burns represented 16.3% of reported injuries. The one-month incidence was calculated to be 1.73%. The most common contributor to burn injury was open flame 36.9%, followed by hot liquids 33.8%. Most burns occurred in urban areas with 88% occurring in the home. A significant association with burn injury was found in the 0–4 age category. There exists a continued need for research examining the mechanisms of safety provision in the home in low resource settings, especially concerning burn injury.

Outcome Measurement Tools Currently Used to Assess Pediatric Burn Patients: An Occupational Therapy and Physiotherapy Perspective

Given the high incidence of burn injuries in children, it is important that all clinicians involved in the care of these patients, including occupational therapists and physiotherapists, are able to assess patients with valid, sensitive, and reliable measurement tools to optimize outcomes and clinical management. The aims of this study were to identify therapist- relevant outcome measurement tools that have been previously used with pediatric burn patients and to ascertain the outcome measurement tools currently used by occupational therapists and physiotherapists working in pediatric burns units. A literature review was undertaken to identify therapist-relevant outcome measurement tools that have been used in the pediatric burn population. A survey involving therapists working in Australian pediatric burns units was then conducted to identify outcome measurement tools in common usage. Few outcome measurement tools were identified that had been specifically validated for use, or were in common usage in Australia, with pediatric patients with burn injury. The lack of validated and widely used measurement tools adversely impacts on the ability of therapists to accurately assess outcomes of treatment and undertake clinical research involving pediatric patients with burn injury.