Table 5.20 Growth Hormone Treatment for Nutritional Management Post ABI
Author Year Country Research Design PEDro Sample Size |
Methods |
Outcomes |
Hatton et al. (2006) USA RCT PEDro=7 N=97 |
Population: TBI; Treatment Group: Mean Age=30yr; Gender: Male=38, Female=11; Mean GCS Score=6.4. Control Group: Mean Age=29yr; Gender: Male=33, Female=15; Mean GCS Score=6.7. Intervention: Patients were randomized to receive either plasma Insulin-like Growth Factor-I (IGF-I) Growth Hormone (GH) or placebo within 72 hr of admission to the hospital. Those in the treatment group received 0.01 mg/kg/hr IV IGF-I by continuous infusion for up to 14 days, as well as 0.05 mg/kg/day subcutaneous GH. Controls were given normal saline but insulin was used to keep glucose concentrations <200 mg/dl. Patients also received concomitant nutritional support (enteral or parenteral). Outcome Measures: Glucose concentrations, energy expenditure, nitrogen balance, protein and calorie intake. |
1. Nutritional endpoints: energy expenditure was slightly different for the two groups (2271±575.6 kcal/day in the control group and 2366±627.8 kcal/day in the treatment group). 2. In the treatment group, the mean daily glucose concentrations were higher than those of the control group (123±24 mg/dl versus 104±11mg/dl; p<0.03). 3. Within the first 24 hr nitrogen balance was positive and it remained positive for the duration of the study. 4. Nitrogen balance was higher for the IGF-I/GH group (p=0.0001). Neither group reached calorie or protein intake goals; groups did not differ significantly in their intake. |
Behrman et al. (1995) USA RCT PEDro=4 N=16 |
Population: Head injury=11, SCI=5; Gender: Male=12, Female=4; Mean GCS score=10. Intervention Group (n=8): Mean Age=23yr. Control Group (n=8): Mean Age=46yr. Intervention: Patients were randomly allocated to receive either intramuscular Growth Hormone (GH; 0.2 mg/kg) every day or 1 mL normal saline (control) for 7-10 days. Assessments were made on days 1, 3, 7, and 10. Outcome Measures: Nitrogen balance, glucose concentration, triglyceride concentrations, thyroid function, serum protein concentration, lymphocyte count, Prognostic Nutritional Index (PNI). |
1. GH treatment did not improve nitrogen balance, glucose concentration, triglyceride concentrations or thyroid function. 2. GH significantly enhanced constitutive serum protein concentrations (transferrin: p<0.05, albumin: p<0.05). 3. Total lymphocyte count was significantly higher in the GH group than in the control group (p<0.05) by day 10. 4. PNI was significantly improved in the GH group compared to the control group (p<0.05) by day 10. |
Devesa et al. (2013) Spain Case Series N=13 |
Population: TBI; Mean Age=26.7yr; Gender: Male=8, Female=5; Time Post Injury=2.5 mo-11 yr. Intervention: Patients with a TBI who were with and without acquired Growth Hormone Deficiency (GHD) all received the same growth hormone treatment protocol, as well as clinical rehabilitation as necessary per individual. Outcome Measures: Plasma Insulin-like Growth Factor I (IGF-I), cognitive and motor improvements. |
1. Plasma IGF-I values increased after GH treatment in GHD and non-GHD patients (p<0.01, p<0.05, respectively). 2. The increase in plasma IGF-I values was significantly higher in GHD than non-GHD patients (p<0.01). 3. In general, cognitive improvements were better than motor improvements. |