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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.