Effects of pre-injury nutritional status on post-burn growth in prepubescent Children

Abstract

Malnutrition is a major problem in the developing world and has disastrous effects on a child’s health and ultimate growth. This study was undertaken to elucidate a possible contributing factor to the altered growth observed and to assess the impact of preinjury malnutrition on growth delay in severely burned children. A retrospective chart review for 89 patients with burn admission dates from 2002 to 2013 at Shriners Hospital for Children, Galveston was done. Only pre-pubertal children were enrolled. These patients were followed in the outpatient clinics for 2 years, and their height, weight, and bone age data were collected at 6-month intervals post discharge. All of the patients were given the standard of care at Shriners Hospital with nutritional supplementation and support. This data was used to determine growth velocities at admission, discharge and each follow-up visit. Weights were also collected on post-surgical day 5 (dry weight) and these were used to calculate the Body Mass Index (BMI) for the patients. These were plotted on standardized Chi Squared analysis and t-tests were used to compare the information for any statistical significance. Of the original 89 patients, 26 (29%) patients were lost to follow-up. Sixty-three patients were assessed via anthropometric standards for malnutrition post-burn injury. The overall prevalence for malnutrition among males was 12% (95% Agresti-Coull CI from 7% to 20%), and amongst females was 25% (95% CI from 14% to 40%) (Figure 1). At the year one-time point, 22 (35%) of patients had abnormal growth velocities, out of these 22 patients, 14% were found to be malnourished prior to injury (p=0.76). At year two only 15(24%) of the patients failed to achieve adequate growth velocity for age, and 33% of these were found to be malnourished (p=0.02) (Table 2).Although malnutrition is a significant problem in the admissions to any burn unit, preinjury malnutrition in pre pubertal children does not have any detrimental effects on the ability of burns survivors to gain normal growth parameters when appropriate nutritional supplementation is achieved.