Growth hormone therapy in pediatric hypercatabolic state: a systematic review and meta-analysis - Critical Care Science (CCS)
BACKGROUND AND OBJECTIVES: To assess the use of recombinant human growth hormone (rhGH) in pediatric patients with hypercatabolic state in the pediatric intensive care unit. METHODS: We searched the databases of MedLine (1990 to 2005), LILACS (1990 to 2005), OVID (1990 to 2006) and EMBASE (1990 to 2005). Randomized controlled trials in pediatric patients using rhGH for hypercatabolic state (burns, sepsis) were selected. Intervention included rhGH therapy versus placebo. Data were extracted in duplicate and independently. Meta-analyses were performed using the software Review Manager statistic tools, with Mantel-Haenzel method for dichotomous outcomes and inverse variance method for continuous. RESULTS: There were evidences that rhGH in burned pediatric patients can reduce exogenous albumin requirement, with a improvement in Lean Body Mass, and accelerate site-donor wound healing, with no effects on mortality. Possibly can reduce the length of hospital stay. Hyperglycemia was the most frequently reported adverse event. CONCLUSIONS: This review suggests that the early application of rhGH to standard treatment in pediatric severe burned patients has the potential to improve some aspects from outcome. At this time, although the literature does not support routine rhGH for pediatric burn patients, consideration should be given to its use in this group, at least as an aim for further research. For use in septic patients, no proper statement can be done.
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BACKGROUND AND OBJECTIVES: To assess the use of recombinant human growth hormone (rhGH) in pediatric patients with hypercatabolic state in the pediatric intensive care unit. METHODS: We searched the databases of MedLine (1990 to 2005), LILACS (1990 to 2005), OVID (1990 to 2006) and EMBASE (1990 to 2005). Randomized controlled trials in pediatric patients using rhGH for hypercatabolic state (burns, sepsis) were selected. Intervention included rhGH therapy versus placebo. Data were extracted in duplicate and independently. Meta-analyses were performed using the software Review Manager statistic tools, with Mantel-Haenzel method for dichotomous outcomes and inverse variance method for continuous. RESULTS: There were evidences that rhGH in burned pediatric patients can reduce exogenous albumin requirement, with a improvement in Lean Body Mass, and accelerate site-donor wound healing, with no effects on mortality. Possibly can reduce the length of hospital stay. Hyperglycemia was the most frequently reported adverse event. CONCLUSIONS: This review suggests that the early application of rhGH to standard treatment in pediatric severe burned patients has the potential to improve some aspects from outcome. At this time, although the literature does not support routine rhGH for pediatric burn patients, consideration should be given to its use in this group, at least as an aim for further research. For use in septic patients, no proper statement can be done.
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