Special considerations in paediatric burn patients

ABSTRACT

Burn injuries are a major cause of morbidity and mortality in children. In India, the figure constitutes about one-fourth of the total burn accidents. The management of paediatric burns can be a major challenge for the treating unit. One has to keep in mind that “children are not merely small adults”; there are certain features in this age group that warrant special attention. The peculiarities in the physiology of fluid and electrolyte handling, the uniqueness of the energy requirement and the differences in the various body proportions in children dictate that the paediatric burn management should be taken with a different perspective than for adults. This review article would deal with the special situations that need to be addressed while treating this special class of thermal injuries. We must ensure that not only the children survive the initial injury, but also the morbidity and complications are minimized. If special care is taken during the initial management of paediatric burn injuries, these children can be effectively integrated into the society as very useful and productive members.

KEY WORDS

Burn injuries - paediatric - special considerations

• REFERENCES

• 1 Reed JL, Pomerantz WJ. Emergency management of pediatric burns. Pediatr Emerg Care 2005;21:118-29
• 2 Ahuja RB, Bhattacharya S. An analysis of 11,196 burn admissions and evaluation of conservative management technique. Burns 2002;28:555-61.
• 3 Gupta M, Gupta OK, Yaduvanshi RK, Upadhyaya J. Burn epidemiology: The Pink City scene. Burns 1993;19:47-51.
• 4 Lowell G, Quinlan K, Gottlieb LJ. Preventing unintentional scald burns: Moving beyond tap water. Pediatrics 2008;122:799-804.
• 5 Lund C, Browder NC. The estimation of areas of burns. Surg Gynecol Obstet 1944;79:352-8.
• 6 Palmieri TL. Pediatric burn management. Problems in General Surgery. Vol. 20. Philadelphia Lippincott Williams and Wilkins; 2003. p. 27-36.
• 7 Merrell SW, Saffle JR, Sullivan JJ, Navar PD, Kravitz M, Warden GD. Fluid resuscitation in thermally injured children. Am J Surg 1986;152:664-9.
• 8 Graves TA, Cioffi WG, McManus WF, Mason AD Jr, Pruitt BA Jr. Fluid resuscitation of infants and children with massive thermal injury. J Trauma 1988;28:1656-9.
• 9 Carvajal HF. Resuscitation of burn children. In: Carvajal HF, Parks DH, editors. Burns in Children: Pediatric Burn Management. Chicago: Year Book Medical Publishers; 1988. p. 78-88.
• 10 Warden GD. Fluid resuscitation and early management. In: Herndon D, editor. Total Burn Care. Philadelphia, PA: WB Saunders Co; 1996. p. 53-60.
• 11 Greenhalgh DG, Warden GD. The importance of intra-abdominal pressure measurements in burned children. J Trauma 1994;36:685-90.
• 12 Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984;199:28-30.
• 13 Schecter N, Allen DA, Hanson K. Status of pediatric pain control: A comparison of hospital analgesic usage in children and adults. Pediatrics 1986;77:11-5.
• 14 Meyer WJ, Nichols RJ, Cortiella J, Villarreal C, Marvin JA, Blakeney PE, Herndon DN. Acetaminophen in the management of background pain in children post-burn. J Pain Symptom Manage. 1997;13:50-5.
• 15 Enzi G, Casadei A, Sergi G, Chiarelli A, Zurlo F, Mazzoleni F. Metabolic and hormonal effects of early nutritional supplementation after surgery in burn patients. Crit Care Med 1990;18:719-21.
• 16 McDonald WS, Sharp CW, Deitch EA. Immediate enteral feeding in burn patients is safe and effective. Ann Surg 1991;213:177-83.
• 17 Hildreth MA, Herndon DN, Desai MH, Duke MA. Caloric requirements of patients with burns under 1 year of age. J Burn Care Rehabil 1993;14:108-12.
• 18 Day T, Dean P, Adams MC, Luterman A, Ramenofsky ML, Curreri PW Nutritional requirements of the burned child: The Curreri Junior Formula. Proc Am Burn Assoc 1986;18:86-91.
• 19 Hildreth MA, Herndon DN, Desai MH, Broemeling LD. Current treatment reduces calories required to maintain weight in pediatric patients with burns. J Burn Care Rehabil 1990;11:405-9.
• 20 Matsuda T, Kagan RJ, Hanumadass M, Jonasson O. The importance of burn wound size in determining optimal calorie nitrogen ratio. Surgery 1983;94:562-8.
• 21 Hildreth M, Gottschlich M. Nutritional support of the burned patient. In: Herndon D, editor. Total Burn Care. Philadelphia, PA: WB Saunders Co; 1996. p. 237-45.
• 22 Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev. 2006; 19:403-34.
• 23 Pietsch JB, Netscher DT, Nagaraj HS, Groff DB. Early excision of major burns in children: Effect on morbidity and mortality. J Pediatr Surg 1985;20:754-7.
• 24 Muller MJ, Herndon DN. The challenge of burns. Lancet 1994;343:216-20.
• 25 Sheridan RL, Remensnyder JP, Schnitzer JJ, Schulz JT, Ryan CM, Tompkins RG. Current expectations for survival in pediatric burns. Arch Pediatr Adolesc Med 2000;154:245-9.
• 26 Ryan CM, Schoenfeld DA, Thorpe WP, Sheridan RL, Cassem EH, Tompkins RG. Objective estimates of probability of death from burn injuries. N Engl J Med 1998;338:362-6.
• 27 Chan MM, Chan GM. Nutritional therapy for burns in children and adults. Nutrition 2009;25:261-9.
• 28 Jeschke MG, Finnerty CC, Kulp GA, Przkora R, Micak RP, Herndon DN. Combination of recombinant human growth hormone and propanol decreases hypermetabolism and inflammation in severely burned children. Pediatr Crit Care Med 2008;9:209-16.