***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : Dopamine , a natural catecholamine with hypophysiotropic properties , is used as a first choice drug for inotropic and vasoactive support in pediatric intensive care . In infants and children , the pituitary gl and plays a crucial role as a regulator of growth , metabolism , maturation and , possibly , immune function . We evaluated the effect of dopamine infusion ( 5 & mgr;g/kg/min iv ) on the dynamics of prolactin , growth hormone , and thyrotropin secretion and on the thyroid axis in critically ill infants and children . Design : Prospect i ve , r and omized , controlled , open‐labeled , clinical study . Setting : Intensive care unit of a university hospital over a 9‐month period . Patients and Methods : The study population consisted of infants and children recovering from cardiovascular surgery . The group was stratified into two age groups ( infants aged 12 to 90 days [ n = 18 ] and children aged 0.3 to 6.7 yrs [ n = 15 ] ) and was studied dynamically ( blood sampling every 20 mins for 3 hrs ) on two consecutive days , after r and omization for dopamine withdrawal on the first or the second day . Serum prolactin , growth hormone , insulin‐like growth factor‐1 , thyrotropin , thyroxine ( T4 ) , triiodothyronine ( T3 ) , and reverse triiodothyronine ( reverse T3 ) concentrations were measured . Measurements and Main Results : In the newborns  , dopamine was found to suppress prolactin , growth hormone , and thyrotropin secretion consistently , rebound releases starting within 20 mins after dopamine withdrawal . One day later , prolactin concentrations were ten times higher , pulsatile growth hormone secretion was augmented , thyrotropin was unchanged , but T3 was increased by 30 % and the T3/reverse T3 ratio was inverted . In the children  , dopamine suppressed prolactin and thyrotropin ( but not growth hormone ) secretion , rebound releases starting within 20 mins after dopamine withdrawal . One day later , prolactin concentrations were at least twice as high , thyrotropin was increased ten‐fold , T4 was augmented by 14 % , T3 by 30 % and the T3/reverse T3 ratio had doubled . Neither in newborns nor in children did dopamine withdrawal appear to affect the low serum insulin‐like growth factor‐1 concentrations . Conclusions : The data indicate that dopamine infusion induces or aggravates partial hypopituitarism and the euthyroid sick syndrome in critically ill infants and children . ( Crit Care Med 1994 ; 22:1747–1753 We tested the hypothesis that the administration of recombinant human growth hormone ( rHGH ) and exercise would increase lean body mass ( LBM ) and muscle strength in burned children to a greater extent than rHGH or exercise separately . Children , ages 7 - 17 yr , with > 40 % body surface area burned , were r and omized into groups . One group ( GHEX , n = 10 ) participated in a 12-wk in-hospital physical rehabilitation program supplemented with an exercise program and received 0.05 mg . kg(-1 ) . day(-1 ) of rHGH . A second exercising group ( SALEX , n = 13 ) received saline . A third group ( GH , n = 10 ) received a similar dose of rHGH as GHEX and participated in a 12-wk , home-based physical rehabilitation program without exercise . The fourth group ( Saline , n = 11 ) received saline and participated in a 12-wk , home-based physical rehabilitation program without exercise . The mean ( + /-SE ) percent change in lean body mass after 12 wk was not significantly different between GHEX ( 9.0 + /- 2.1 % ) , SALEX ( 5.4 + /- 1.6 % ) , and GH ( 5.8 + /- 1.8 % ) groups ( P = 0.33 ) . However , the mean percent change in muscle strength was significantly greater in the GHEX ( 36.2 + /- 5.4 % ) and SALEX ( 42.6 + /- 10.0 % ) groups than in the GH ( -7.4 + /- 4.7 % ) or Saline ( 6.7 + /- 4.4 % ) groups ( P = 0.008 ) . In summary , rHGH GHEX , SALEX , and GH alone produced similar improvements in LBM . However , muscle strength was only increased via exercise BACKGROUND Recombinant human growth hormone ( rhGH ) has been shown to favorably modulate the acute-phase response and may improve the clinical outcome . OBJECTIVE To examine whether rhGH attenuates the elevated tumor necrosis factor alpha ( TNF-alpha ) levels that correlate with increased multiorgan failure and mortality in burned adults and children . DESIGN Twenty children with burns of greater than 40 % of the total body surface area were r and omly divided into 2 groups to receive placebo ( n = 10 ) or rhGH , 0.2 mg/kg per day intramuscularly ( n = 10 ) . SETTING Pediatric burn hospital . MAIN OUTCOME MEASURE Serum TNF-alpha levels by enzyme-linked immunoassay at baseline ( day 0 ) and at 21 and 42 days after injury . For statistical analysis , we used the Kruskal-Wallis and Friedman tests . RESULTS No significant differences in age ( mean + /- SD , 6.2+/-1.6 vs 5.0+/-1.2 years ) or percentage of total body surface area burn ( mean + /- SD , 65.1%+/-8.2 % vs 57.1%+/-5.2 % ) could be shown between the groups given rhGH and placebo .  Baseline TNF-alpha levels were elevated from reference values in both groups . Twenty-one and 42 days after rhGH administration , serum TNF-alpha levels were significantly decreased from those at baseline ( P<.05 ) . No significant decrease in TNF-alpha levels was observed in the placebo group ( P = .5 ) . CONCLUSIONS Recombinant human growth hormone significantly lowers serum TNF-alpha levels after burn injury . This is consistent with the beneficial effect that rhGH has on the acute-phase response Objective To determine whether the beneficial effects of growth hormone persist throughout the prolonged hypermetabolic and hypercatabolic response to severe burn . Summary Background Data The hypermetabolic response to severe burn is associated with increased energy expenditure , insulin resistance , immunodeficiency , and whole body catabolism that persists for months after injury . Growth hormone is a potent anabolic agent and salutary modulator of posttraumatic metabolic responses . Methods Seventy-two severely burned children were enrolled in a placebo-controlled double-blind trial investigating the effects of growth hormone ( 0.05 mg/kg per day ) on muscle accretion and bone growth . Drug or placebo treatment began on discharge from the intensive care unit and continued for 1 year after burn . Total body weight , height , dual-energy x-ray absorptiometry , indirect calorimetry , and hormone values were measured at discharge , then at 6 months , 9 months , and 12 months after burn . Results were compared between groups . Results Growth hormone subjects gained more weight than placebo subjects at the 9-month study point ; this disparity in weight gain continued to exp and throughout the remainder of the study . Height also increased in the growth hormone group compared with controls at 12 months . Change in lean body mass was greater in those treated with growth hormone at 6 , 9 , and 12 months . Bone mineral content was increased at 9 and 12 months ; this was associated with higher parathormone levels . Conclusions Low-dose recombinant human growth hormone successfully abates muscle catabolism and osteopenia induced by severe burn The beneficial effects of growth hormone on wound healing in severely burned children were studied . Forty patients who were 2 to 18 years old , with 40 % or more total body surface area ( TBSA ) and 20 % or more TBSA full-thickness flame or scald burns , were r and omized in a double-blind study to receive placebo or 0.1 mg/kg/day recombinant human growth hormone ( rHGH ) until the first donor site healed or to receive 0.2 mg/kg/day rHGH or placebo from admission throughout hospitalization . Patients receiving 0.2 mg/kg/day rHGH demonstrated significantly higher serum IGF-1 levels at 4.8 + /- 1.7 U/mL compared to placebos at 1.6 + /- 0.4 U/mL ( p less than 0.05 ) and a significant decrease in donor-site healing times compared to placebo ( p less than 0.05 ) . Length of hospital stay ( LOS/%TBSA ) was decreased from 0.80 + /- 0.10 days/%TBSA burned in the placebo group to 0.54 + /- 0.04 days/%TBSA burned in the 0.2 mg/kg/day treatment group ( p less than 0.05 ) . This translates , for the average 60 % TBSA burned patient , to a decrease in LOS from 46 to 32 days Objectives To describe the sequential changes in the growth hormone (GH)/insulin-like growth factors axis and their relationship with nitrogen balance in children following cardiac surgery .  Design Prospect i ve , descriptive study . Setting Pediatric intensive care unit of a university hospital . Patients Twenty three postoperative cardiac surgical patients after bypass . Interventions Blood and urine sample s were taken on days 1 , 2 , and 7 of pediatric intensive care unit admission . An intraanesthesia , presurgery sample was also obtained . Measurements and Main Results Serum concentrations of insulin , insulin growth factor-I ( IGF-I ) , insulin growth factor binding proteins 1 and 3 ( IGFBP-1 and IGFBP-3 ) , growth hormone binding protein ( GHBP ) , and urinary concentrations of GH and free cortisol ( UFC ) were measured on days 1 , 2 , and 7 of the study period . C-reactive protein and prealbumin , were also measured in blood sample s as conventional markers of inflammatory or nutritional status . Pediatric Risk of Mortality II score and UFC were used as indicators of acute stress . The nitrogen balance and urinary nitrogen urea excretion were used as markers of catabolic state . Urinary concentrations of GH were high from days 1 to 7 . Plasma concentrations of IGF-I and GHBP were low and remained low throughout the study period . IGFBP-3 levels were below normal but without reaching statistical significance . The IGFBP-1 levels were initially high but descended progressively toward normal values . Urinary nitrogen urea production was persistently elevated and was associated with a negative nitrogen balance . No relationship was found between nitrogen balance and IGF-I , prealbumin , or C-reactive protein . Conclusions A GH-resistant state is observed in postoperative children following cardiac surgery . Stress response is characterized by an elevation of growth hormone secretion that is not followed by the corresponding increment in IGF-I and IGFBP-3 concentrations . These hormonal changes may be permissive for the catabolic state of these patients . IGF-I and IGFBP-1 and -3 are not related to either nitrogen balance or urinary nitrogen urea excretion Very preterm infants developing bronchopulmonary dysplasia frequently show a compromised growth in the neonatal period especially when steroids are given to facilitate weaning from the ventilator . The aim of this study was to evaluate the short-term effect of dexamethasone ( DEXA ) on the GH-IGF axis in ventilated very preterm infants developing bronchopulmonary dysplasia . We studied 10 very preterm artificially ventilated infants with bronchopulmonary dysplasia [ median ( range ) gestational age 27.5 wk ( 25.9 - 32.0 wk ) , median ( range ) birth weight 970 g ( 610 - 2150 g ) ] immediately before and 2 d after the start of DEXA treatment  . On both days of study , serum GH profiles were obtained , and serum IGF-I and IGF binding protein ( IGFBP ) −1 and −3 levels were measured . The ventilation score and the nutritional intake were calculated . Before the start of DEXA treatment , the median serum mean GH level was 12.0 μg/L ( 6 - 28.4 μg/L ) , whereas 2 d after the start of DEXA  treatment the median serum mean GH level declined significantly to a value of 4.4 μg/L ( 1.7 - 11.9 μg/L ) . During DEXA  treatment , mean , baseline , and maximal GH levels ( Pulsar analysis ) were significantly lower compared with pretreatment levels ( p < 0.01 , p < 0.01 , and p < 0.05 , respectively ) . Serum IGF-I and IGFBP-3 levels did not decline during DEXA . Serum IGFBP-1 levels were significantly lower compared with pretreatment levels ( p < 0.01 ) . Serum GH levels  during DEXA treatment were correlated with neither the time interval between the administration of DEXA and the second GH profile nor the cumulative DEXA dose administered . Ventilation score and nutritional int 
    Output:
    
RESULTS There were evidence s that rhGH in burned pediatric patients can reduce exogenous albumin requirement , with a improvement in Lean Body Mass , and accelerate site-donor wound healing , with no effects on mortality .
Possibly can reduce the length of hospital stay .
Hyperglycemia was the most frequently reported adverse event .
This review suggests that the early application of rhGH to st and ard treatment in pediatric severe burned patients has the potential to improve some aspects from outcome .