Long-term Effects of Pediatric Burns on the Circulatory System

Duke, Janine M.; Randall, Sean; Fear, Mark W.; Boyd, James H.; Rea, Suzanne; Wood, Fiona

doi:10.1542/peds.2015-1945

Cited by 37 publications

(19 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…based on differential responsive burn treatments and is the standard classification used in Western Australia Population-based Burn Injury Project studies. 24,33,34 Baseline comorbidity (yes/no) was assessed with a 5-year lookback period 35 using the Charlson comorbidity index 36 and the principal and additional diagnoses data in the hospital morbidity records. Congenital anomaly was identified using principal and additional diagnoses (ICD-10-AM: Q00-G99).…”

Section: Methodsmentioning

confidence: 99%

Respiratory Morbidity After Childhood Burns: A 10-Year Follow-up Study

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

Respiratory Morbidity After Childhood Burns: A 10-Year Follow-up Study

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Data by Duke et al suggest that adult and pediatric burn survivors are more prone to sequelae of cardiovascular disease later in life. 8 , 9 However, no prospective studies have followed a cohort of survivors to assess the progression of morphologic and functional changes. Based on data showing systolic and diastolic dysfunction as well as myocardial fibrosis to be independent risk factors for poor cardiovascular and overall health, it is reasonable to assume that, in children surviving burn injury, cardiovascular disease burden may increase disproportionally later in life.…”

Section: Discussionmentioning

confidence: 99%

“… 7 Two recent population-based longitudinal studies were conducted in adults who sustained burn injuries as children or young adults to assess long-term morbidity and mortality due to a variety of cardiovascular diagnoses. 8 , 9 Although the spectrum of cardiovascular diagnoses included in these analyses was broad, the authors reported significant increases in incidence and length of hospitalization as well as mortality related to cardiovascular disease among middle-aged survivors of pediatric burn injury. The importance of this clinical problem may be considerable given that systolic and diastolic dysfunction are powerful predictors of poor cardiovascular prognosis, morbidity, and mortality in young adults.…”

Section: Introductionmentioning

confidence: 99%

Long-term effect of critical illness after severe paediatric burn injury on cardiac function in adolescent survivors: an observational study

Hundeshagen

Herndon

Clayton

et al. 2017

The Lancet Child & Adolescent Health

View full text Add to dashboard Cite

BackgroundSepsis, trauma, and burn injury acutely depress systolic and diastolic cardiac function; data on long-term cardiac sequelae of pediatric critical illness are sparse. This study evaluated long-term systolic and diastolic function, myocardial fibrosis, and exercise tolerance in survivors of severe pediatric burn injury.MethodsSubjects at least 5 years after severe burn (post-burn:PB) and age-matched healthy controls (HC) underwent echocardiography to quantify systolic function (ejection fraction[EF%]), diastolic function (E/e′), and myocardial fibrosis (calibrated integrated backscatter) of the left ventricle. Exercise tolerance was quantified by oxygen consumption (VO2) and heart rate at rest and peak exercise. Demographic information, clinical data, and biomarker expression were used to predict long-term cardiac dysfunction and fibrosis.FindingsSixty-five subjects (PB:40;HC:25) were evaluated. At study date, PB subjects were 19±5 years, were at 12±4 years postburn, and had burns over 59±19% of total body surface area, sustained at 8±5 years of age. The PB group had lower EF% (PB:52±9%;HC:61±6%; p=0.004), E/e′ (PB:9.8±2.9;HC: 5.4±0.9;p<0.0001), VO2peak (PB:37.9±12;HC: 46±8.32 ml/min/kg; p=0.029), and peak heart rate (PB:161±26;HC:182±13bpm;p=0.007). The PB group had moderate (28%) or severe (15%) systolic dysfunction, moderate (50%) or severe diastolic dysfunction (21%), and myocardial fibrosis (18%). Biomarkers and clinical parameters predicted myocardial fibrosis, systolic dysfunction, and diastolic dysfunction.InterpretationSevere pediatric burn injury may have lasting impact on cardiac function into young adulthood and is associated with myocardial fibrosis and reduced exercise tolerance. Given the strong predictive value of systolic and diastolic dysfunction, these patients might be at increased risk for early heart failure, associated morbidity, and mortality.FundingConflicts of Interest and Sources of Funding: The authors do not have any conflicts of interest to declare. This work was supported by NIH (P50 GM060338, R01 GM056687, R01 HD049471, R01 GM112936, R01-GM56687 and T32 GM008256), NIDILRR (H133A120091, 90DP00430100), Shriners Hospitals for Children (84080, 79141, 79135, 71009, 80100, 71008, 87300 and 71000), FAER (MRTG CON14876), and the Department of Defense (W81XWH-14-2-0162 and W81XWH1420162). It was also made possible with the support of UTMB’s Institute for Translational Sciences, supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences (NIH).

show abstract

“…A long term follow-up study showed that burn injured children had an increased risk of arthritis, fractures, and pulmonary conditions compared to their non-burned peers, even following non-severe burns [ 10 ]. Accordingly, pediatric burn patients had increased hospital admission rates for respiratory infection [ 11 ], cardiovascular diseases [ 12 ], and musculoskeletal diseases [ 13 ], and even an increased risk of mortality in the long-term [ 14 ]. Although the specific causes of those physical and physiological consequences years beyond the burn injury have yet to be identified, lack of physical activity might play a role.…”

Section: Introductionmentioning

confidence: 99%

Physical activity and sedentary behavior following pediatric burns – a preliminary investigation using objective activity monitoring

Akkerman

Mouton

Disseldorp

et al. 2018

BMC Sports Sci Med Rehabil

View full text Add to dashboard Cite

BackgroundAdequate levels of regular physical activity (PA) are crucial for health and well-being. Pediatric burn injuries can have major physiological consequences in both the short and long term. The question is whether these consequences affect post burn PA levels. This study therefore aimed to describe PA and sedentary behavior (SB) in children and adolescents 1–5 years after burn injury.MethodsDaily PA and SB were monitored in 20 children and adolescents (12 boys and 8 girls, aged 6–17 years, with burns covering 10–37% of total body surface area, 1–5 years post burn) for 1 week using the ActiGraph GTX3+ accelerometer. Activity counts were categorized into SB, light PA, moderate PA, vigorous PA, moderate-to-vigorous PA (MVPA), and total PA. Outcomes were compared with non-burned reference values and PA levels recommended by the World Health Organization (WHO).ResultsThe participants spent about 5.1 h per day on total PA and 7.4 h on SB. Most of the active time (~ 83%) was categorized as light PA. Thirty-five percent of the group, especially the young boys, spent on average ≥ 60 min on MVPA per day. The boys, although with large interindividual differences, spent more time on MVPA than the girls (p < .005). Older age was associated with less PA time, while more time was spent sedentary. No trends were found indicating an effect of burn characteristics, time post burn, or length of hospital stay, and no differences were found with non-burned peers.ConclusionDuration and intensity of PA and SB in children and adolescents 1–5 years after burn injury were similar to non-burned peers. However, only 35% of the group met the WHO physical activity recommendation. Given the increased long term risk for physical conditions following pediatric burns, physical activity should be encouraged in this vulnerable population.Trial registrationThe study is registered in the National Academic Research and Collaborations Information System of the Netherlands (OND1348800).Electronic supplementary materialThe online version of this article (10.1186/s13102-018-0093-5) contains supplementary material, which is available to authorized users.

show abstract

Long-term Effects of Pediatric Burns on the Circulatory System

Cited by 37 publications

References 25 publications

Respiratory Morbidity After Childhood Burns: A 10-Year Follow-up Study

Respiratory Morbidity After Childhood Burns: A 10-Year Follow-up Study

Long-term effect of critical illness after severe paediatric burn injury on cardiac function in adolescent survivors: an observational study

Physical activity and sedentary behavior following pediatric burns – a preliminary investigation using objective activity monitoring

Contact Info

Product

Resources

About