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Reversal Of Growth Arrest With The Combined Administration Of Oxandrolone And Propranolol In Severely Burned Children
David N Herndon, Charles Voigt*, Karel Capek*, Paul Wurzer*, Ashley Guillory*, Andrea Kline*, Clark Andersen*, Linda Sousse*, Oscar E Suman*, Celeste C Finnerty*
University of Texas Medical Branch, Galveston, TX

OBJECTIVE(S): In children with massive burn injuries, the hypercatabolic response is mediated by increased production of catecholamines and corticosteroids, coupled with decreased production of testosterone,resulting in decreased strength and growth arrest for up to two years post injury. We previously showed that administration of the β1, β2 adrenoreceptor blocking agent propranolol (4mg/kg/day for one year) decreased cardiac work and resting energy expenditure while increasing peripheral lean mass, and that the testosterone analog oxandrolone (0.1mg/kg/day for one year) improved lean body mass accretion and bone mineral content. Here we determine whether the combined administration of oxandrolone and propranolol have added benefit.
METHODS: In this prospective, randomized, placebo-controlled study of 452 burned children with burns over 53±15 % of total body surface area, we compared the single use of these drugs to the combined use of oxandrolone and propranolol at the same doses for one year post burn.
RESULTS: The combined use of oxandrolone and propranolol conferred an additional benefit on growth; the combined treatment shortened the period of growth arrest by 69 days compared to control (p=0.03), and increased the rate of stature increase when growth resumed by 1.3 cm/yr compared to controls (p=0.002).
CONCLUSIONS: These studies demonstrate that the combined use of oxandrolone and propranolol can attenuate burn induced growth arrest.
Growth Arrest and Growth Rate By Treatment Group
Treatment GroupDays of Growth ArrestGrowth Rate (cm/year)
Control284 ± 176.3 ± 0.2
Oxandrolone199 ± 316.1 ± 0.4
Propranolol254 ± 166.9 ± 0.2
Oxandrolone + Propranolol215 ± 22*7.6 ± 0.3**
Tukey Adjusted p-value , Compared to Control: * p=0.03; ** p=0.002


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