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Long-term propranolol use in severely burned pediatric patients: a randomized controlled study
David N Herndon1, Noe A Rodriguez, Eva C Diaz
1Shriners Hospitals for Children-Galveston, Galveston, TX 77550, USA. dherndon@utmb.edu
Insights
One year of propranolol treatment in pediatric burn patients improved cardiac function and body composition while reducing resting energy expenditure. This long-term propranolol administration demonstrated safety and efficacy in managing post-burn hypermetabolism.
Area of Science:
- Pediatric burn recovery
- Pharmacological interventions for burns
- Metabolic response to injury
Background:
- Severe burns induce a prolonged hypermetabolic state post-injury.
- Short-term propranolol (1 month) can mitigate this hypermetabolic response.
- The long-term benefits of 1-year propranolol administration remain under investigation.
Purpose of the Study:
- To assess the safety and efficacy of 1-year propranolol treatment in pediatric burn patients.
- To evaluate the impact on cardiac function, resting energy expenditure, and body composition.
- To determine sustained benefits beyond initial burn recovery.
Main Methods:
- Prospective, randomized, single-center, controlled study.
- 179 pediatric patients with >30% total body surface area burns were randomized.
- Propranolol (4 mg/kg/d) or placebo administered for 12 months postburn, with regular assessments.
Main Results:
- Long-term propranolol significantly reduced heart rate and resting energy expenditure.
- Improved lean body mass accretion and decreased central fat accumulation.
- Prevented bone loss with minimal adverse effects observed.
Conclusions:
- 12-month propranolol treatment effectively ameliorates hyperdynamic, hypermetabolic, hypercatabolic, and osteopenic responses in pediatric burn patients.
- Demonstrates a favorable safety profile for long-term use.
- Study registered at clinicaltrials.gov: NCT00675714.
Objective:
To determine the safety and efficacy of propranolol given for 1 year on cardiac function, resting energy expenditure, and body composition in a prospective, randomized, single-center, controlled study in pediatric patients with large burns.
Background:
Severe burns trigger a hypermetabolic response that persists for up to 2 years postburn. Propranolol given for 1 month postburn blunts this response. Whether propranolol administration for 1 year after injury provides a continued benefit is currently unclear.
Methods:
One-hundred seventy-nine pediatric patients with more than 30% total body surface area burns were randomized to control (n = 89) or 4 mg/kg/d propranolol (n = 90) for 12 months postburn. Changes in resting energy expenditure, cardiac function, and body composition were measured acutely at 3, 6, 9, and 12 months postburn. Statistical analyses included techniques that adjusted for non-normality, repeated-measures, and regression analyses. P < 0.05 was considered significant.
Results:
Long-term propranolol treatment significantly reduced the percentage of the predicted heart rate and percentage of the predicted resting energy expenditure, decreased accumulation of central mass and central fat, prevented bone loss, and improved lean body mass accretion. There were very few adverse effects from the dose of propranolol used.
Conclusions:
Propranolol treatment for 12 months after thermal injury, ameliorates the hyperdynamic, hypermetabolic, hypercatabolic, and osteopenic responses in pediatric patients. This study is registered at clinicaltrials.gov: NCT00675714.
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