Growth hormone attenuates tumor necrosis factor 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 α (TNF-α) 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 total 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-α 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 surface 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-α levels were elevated from reference values in both groups. Twenty-one and 42 days after rhGH administration, serum TNF-α levels were significantly decreased from those at baseline (P<.05). No significant decrease in TNF-α levels was observed in the placebo group (P = .5). Conclusions: Recombinant human growth hormone significantly lowers serum TNF-α levels after burn injury. This is consistent with the beneficial effect that rhGH has on the acute-phase response.