Growth hormone attenuates tumor necrosis factor α in burned children

Background: Recombinant human growth hormone (rhGH) has been shown to favorably modulate the acute-phase response and may improve: the clinical outcome. Objective: To examine whether rhGH attenuates the elevated tumor necrosis factor alpha (TNF-alpha) levels that correlate with increased multiorgan failure and mortality in burned adults and children. Design: Twenty children with burns of greater than 40% of the to tal body surface area were randomly divided into 2 groups to receive placebo (n = 10) or rhGH, 0.2 mg/kg per day intramuscularly (n = 10). Setting: Pediatric burn hospital. Main Outcome Measure: Serum TNF-alpha levels by enzyme-linked immunoassay at baseline (day 0) and at 21 and 42 days after injury. For statistical analysis, we used the Kruskal-Wallis and Friedman tests. Results: No significant differences in age (mean +/- SD, 6.2 +/- 1.6 vs 5.0 +/- 1.2 years) or percentage of total body sm:face area burn (mean +/- SD, 65.1% +/- 8.2% vs 57.1% +/- 5.2%) could be shown between the groups given rhGH and placebo. Baseline TNF-alpha levels were elevated from reference values in both groups. Twenty-one and 42 days after rhGH administration, serum TNF-alpha levels were significantly decreased from those at baseline (P < .05). No significant decrease in TNF-alpha levels was observed in the placebo group (P = .5). Conclusions: Recombinant human growth hormone significantly lowers serum TNF-alpha levels after burn injury. This is consistent with the beneficial effect that rhGH has on the acute-phase response.