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Steroid administration potentiates urinary nitrogen losses in head-injured children
E G Ford1, L M Jennings, R J Andrassy
1Department of Surgery, University of Texas Health Science Center at Houston.
Insights
Steroids worsen nitrogen loss in children with head injuries, increasing protein breakdown. Aggressive nutritional support is crucial for these patients to counteract this catabolic effect.
Area of Science:
- Pediatric critical care
- Trauma management
- Endocrinology
Background:
- Exogenous steroid administration increases post-traumatic nitrogen excretion in adults.
- Children with head injuries treated with steroids show increased urinary nitrogen, related to injury severity (Modified Injury Severity Score - MISS).
- The cause of increased protein breakdown (head injury vs. steroid catabolism) in pediatric head injury patients is unclear.
Purpose of the Study:
- To investigate whether steroid administration potentiates post-traumatic protein breakdown in children with head injuries.
- To compare nitrogen excretion in head-injured children with and without steroid treatment.
Main Methods:
- Prospective study of 19 children (aged 4-14 years) with head injuries.
- Ten children received dexamethasone (1-1.5 mg/kg/day for 3-5 days); nine did not.
- Groups were matched for age, weight, MISS, and Glasgow Coma Scale Score.
Main Results:
- The steroid-treated group exhibited significantly higher urinary nitrogen excretion (mean, 256 ± 24 mg/kg/day) compared to the nonsteroid group (mean, 172 ± 29 mg/kg/day) (p < 0.02).
- This indicates steroids potentiate the catabolic response post-head injury in children.
Conclusions:
- Steroid use exacerbates post-traumatic protein breakdown in pediatric head injury.
- Aggressive nutritional support is essential for managing children with head injuries who are treated with steroids.
Abstract:
Exogenous steroid administration has been shown to increase post-traumatic nitrogen excretion in adults. Children sustaining head injuries and treated with steroids have previously been shown to have markedly increased total urinary nitrogen levels; the amount of nitrogen excreted is also directly related to the degree of injury, as evidenced by the Modified Injury Severity Score (MISS). It is unclear whether the increased protein breakdown in these patients is a result of the head injury or a result of the catabolic effects of steroids. Nineteen children aged 4-14 years, suffering head injuries, were prospectively studied. In ten children, management included steroid administration (1-1.5 mg/kg/day dexamethasone X 3-5 days); the remaining nine were similarly managed; however, without steroids. The groups were matched for age, weight, MISS, and Glasgow Coma Scale Score. The steroid-treated group showed a significantly higher urinary nitrogen excretion (mean, 256 +/- 24 mg/kg/day) than the nonsteroid-treated group (mean, 172 +/- 29 mg/kg/day) (p less than 0.02). These data suggest that steroids potentiate an already accelerated post-traumatic catabolic response seen in children with head injuries. Our data suggest that steroid use, which is common, mandates aggressive nutritional support in the management of children with head injuries.