{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T13:16:44Z","timestamp":1793798204670,"version":"4.6.1"},"reference-count":135,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EBJ"],"abstract":"<jats:p>Background: Burn injuries constitute a significant global health challenge, especially in pediatric populations, where they are a leading cause of morbidity and mortality. Pediatric burns require particular attention due to their unique pathophysiology, long-term consequences on growth and development, and psychological impacts. Methods: We propose a comprehensive review of recent advancements in understanding the key aspects of hormonal and metabolic changes in burned children, aiming to guide therapeutic interventions, improve outcomes, and reduce the global burden of these injuries. Results: Effective management of the physiological stress response in pediatric burn patients necessitates a multidisciplinary approach integrating medical, nutritional, and rehabilitative strategies. Timely nutritional support and individualized plans preserve muscle mass, promote wound healing, and reduce complications and organ dysfunction risk. Advances in pharmacological interventions, such as beta-blockers, anabolic agents, and hormonal treatment, offer promising pathways to improve recovery and mitigate long-term complications. Early mobilization and physiotherapy are essential for preventing complications of prolonged immobility, including muscle wasting, joint contractures, and functional decline; their effectiveness is closely tied to advancements in minimally invasive procedures, regenerative medicine, and reconstructive techniques, particularly for pediatric patients. Conclusions: While current strategies have significantly improved survival and outcomes for pediatric burn patients, ongoing research is critical to refine these new care strategies.<\/jats:p>","DOI":"10.3390\/ebj6020017","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T20:43:17Z","timestamp":1745440997000},"page":"17","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Metabolic and Hormonal Changes in Pediatric Burn Patients: Mechanisms, Evidence, and Care Strategies"],"prefix":"10.3390","volume":"6","author":[{"given":"Gloria","family":"Pelizzo","sequence":"first","affiliation":[{"name":"Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy"},{"name":"Pediatric Surgery Department, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2137-5974","authenticated-orcid":false,"given":"Valeria","family":"Calcaterra","sequence":"additional","affiliation":[{"name":"Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy"},{"name":"Pediatric Department, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Marinaro","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Baldassarre","sequence":"additional","affiliation":[{"name":"Pediatric Department, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta Paola Maria","family":"Canonica","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2795-9874","authenticated-orcid":false,"given":"Gianvincenzo","family":"Zuccotti","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41572-020-0145-5","article-title":"Burn Injury","volume":"6","author":"Jeschke","year":"2020","journal-title":"Nat. Rev. Dis. Primer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/MOP.0000000000000902","article-title":"Pediatric Burn Care: New Techniques and Outcomes","volume":"32","author":"Partain","year":"2020","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1053\/j.sempedsurg.2014.11.008","article-title":"Overview of Current Pediatric Burn Care","volume":"24","author":"Gonzalez","year":"2015","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jeschke, M.G., Gauglitz, G.G., Kulp, G.A., Finnerty, C.C., Williams, F.N., Kraft, R., Suman, O.E., Mlcak, R.P., and Herndon, D.N. (2011). Long-Term Persistance of the Pathophysiologic Response to Severe Burn Injury. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0021245"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100709","DOI":"10.1016\/j.cpsurg.2019.100709","article-title":"Current Problems in Burn Hypermetabolism","volume":"57","author":"Sommerhalder","year":"2020","journal-title":"Curr. Probl. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1053\/j.sempedsurg.2019.01.013","article-title":"Early Resuscitation and Management of Severe Pediatric Burns","volume":"28","author":"Arbuthnot","year":"2019","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10710","DOI":"10.15766\/mep_2374-8265.10710","article-title":"Pediatric Emergency Medicine Simulation Curriculum: Electrical Injury","volume":"14","author":"Berry","year":"2018","journal-title":"MedEdPORTAL"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1016\/S0140-6736(13)61093-4","article-title":"Burns in Children: Standard and New Treatments","volume":"383","author":"Jeschke","year":"2014","journal-title":"Lancet"},{"key":"ref_9","first-page":"76","article-title":"Burns in Children","volume":"7","author":"Fenlon","year":"2007","journal-title":"BJA Educ."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s41038-017-0076-x","article-title":"Nutrition and Metabolism in Burn Patients","volume":"5","author":"Clark","year":"2017","journal-title":"Burns Trauma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1016\/j.burns.2014.09.012","article-title":"Do Silver-Based Wound Dressings Reduce Pain? A Prospective Study and Review of the Literature","volume":"40","author":"Abboud","year":"2014","journal-title":"Burns"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1097\/01.pec.0000159058.95424.0d","article-title":"Emergency Management of Pediatric Burns","volume":"21","author":"Reed","year":"2005","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.addr.2017.09.018","article-title":"Burn Injury: Challenges and Advances in Burn Wound Healing, Infection, Pain and Scarring","volume":"123","author":"Wang","year":"2018","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Toma, A., Voicu, D., Popazu, C., Mihalache, D., Duca, O., D\u0103nil\u0103, D.M., and Enescu, D.M. (2024). Severity and Clinical Outcomes of Pediatric Burns\u2014A Comprehensive Analysis of Influencing Factors. J. Pers. Med., 14.","DOI":"10.3390\/jpm14080788"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.metabol.2019.06.001","article-title":"The Role of the Musculoskeletal System in Post-Burn Hypermetabolism","volume":"97","author":"Klein","year":"2019","journal-title":"Metabolism"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.cps.2017.02.013","article-title":"Metabolic and Endocrine Considerations After Burn Injury","volume":"44","author":"Williams","year":"2017","journal-title":"Clin. Plast. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/SLA.0b013e3181856241","article-title":"Pathophysiologic Response to Severe Burn Injury","volume":"248","author":"Jeschke","year":"2008","journal-title":"Ann. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Korzeniowski, T., Mertowska, P., Mertowski, S., Podgajna, M., Grywalska, E., Stru\u017cyna, J., and Torres, K. (2022). The Role of the Immune System in Pediatric Burns: A Systematic Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11082262"},{"key":"ref_19","unstructured":"Herndon, D.N. (2018). Total Burn Care, Elsevier. [5th ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Guillory, A.N., Porter, C., Suman, O.E., Zapata-Sirvent, R.L., Finnerty, C.C., and Herndon, D.N. (2018). Modulation of the Hypermetabolic Response After Burn Injury. Total Burn Care, Elsevier.","DOI":"10.1016\/B978-0-323-47661-4.00029-0"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1056\/NEJMoa010342","article-title":"Reversal of Catabolism by Beta-Blockade After Severe Burns","volume":"345","author":"Herndon","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"337","DOI":"10.2119\/molmed.2009.00005","article-title":"The Hepatic Response to Thermal Injury: Is the Liver Important for Postburn Outcomes?","volume":"15","author":"Jeschke","year":"2009","journal-title":"Mol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.cps.2009.05.001","article-title":"The Hypermetabolic Response to Burn Injury and Interventions to Modify This Response","volume":"36","author":"Williams","year":"2009","journal-title":"Clin. Plast. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/BCR.0000000000000265","article-title":"Postburn Hypermetabolism: Past, Present, and Future","volume":"37","author":"Jeschke","year":"2016","journal-title":"J. Burn Care Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.burns.2005.10.023","article-title":"Resting Energy Expenditure in Severely Burned Children: Analysis of Agreement Between Indirect Calorimetry and Prediction Equations Using the Bland\u2013Altman Method","volume":"32","author":"Suman","year":"2006","journal-title":"Burns"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s12098-008-0035-4","article-title":"Respiratory Viruses in Acute Respiratory Tract Infections in Western India","volume":"75","author":"Yeolekar","year":"2008","journal-title":"Indian J. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Toliver-Kinsky, T., Kobayashi, M., Suzuki, F., and Sherwood, E.R. (2018). The Systemic Inflammatory Response Syndrome. Total Burn Care, Elsevier.","DOI":"10.1016\/B978-0-323-47661-4.00019-8"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1001\/archsurg.139.6.641","article-title":"Extended Hypermetabolic Response of the Liver in Severely Burned Pediatric Patients","volume":"139","author":"Jeschke","year":"2004","journal-title":"Arch. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1123\/pes.24.1.2","article-title":"Child\u2014Adult Differences in Muscle Activation\u2014A Review","volume":"24","author":"Dotan","year":"2012","journal-title":"Pediatr. Exerc. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"C58","DOI":"10.1152\/ajpcell.00106.2021","article-title":"Burn-Induced Hypermetabolism and Skeletal Muscle Dysfunction","volume":"321","author":"Knuth","year":"2021","journal-title":"Am. J. Physiol.-Cell Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Klein, G.L. (2018). The Role of Calcium in Inflammation-Associated Bone Resorption. Biomolecules, 8.","DOI":"10.3390\/biom8030069"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/00000658-200010000-00001","article-title":"Determinants of Skeletal Muscle Catabolism After Severe Burn","volume":"232","author":"Hart","year":"2000","journal-title":"Ann. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1016\/j.burns.2018.04.014","article-title":"Bone Metabolism in Pediatric Burned Patients: A Review","volume":"44","author":"Schryver","year":"2018","journal-title":"Burns"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/BCR.0000000000000308","article-title":"Long-Term Skeletal Muscle Mitochondrial Dysfunction Is Associated with Hypermetabolism in Severely Burned Children","volume":"37","author":"Porter","year":"2016","journal-title":"J. Burn Care Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1152\/jappl.2001.91.3.1168","article-title":"Effects of a 12-Wk Resistance Exercise Program on Skeletal Muscle Strength in Children with Burn Injuries","volume":"91","author":"Suman","year":"2001","journal-title":"J. Appl. Physiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1067\/msy.2000.108059","article-title":"Persistence of Muscle Catabolism After Severe Burn","volume":"128","author":"Hart","year":"2000","journal-title":"Surgery"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(16)31469-6","article-title":"The Metabolic Stress Response to Burn Trauma: Current Understanding and Therapies","volume":"388","author":"Porter","year":"2016","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1152\/ajpendo.00562.2007","article-title":"Postburn Trauma Insulin Resistance and Fat Metabolism","volume":"294","author":"Cree","year":"2008","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1038\/s41419-019-2103-2","article-title":"Browning of White Adipose Tissue After a Burn Injury Promotes Hepatic Steatosis and Dysfunction","volume":"10","author":"Abdullahi","year":"2019","journal-title":"Cell Death Dis."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Johnson, B.Z., McAlister, S., McGuire, H.M., Palanivelu, V., Stevenson, A., Richmond, P., Palmer, D.J., Metcalfe, J., Prescott, S.L., and Wood, F.M. (2020). Pediatric Burn Survivors Have Long-Term Immune Dysfunction with Diminished Vaccine Response. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.01481"},{"key":"ref_41","first-page":"100","article-title":"The Role of Mitochondrial Stress in Muscle Wasting Following Severe Burn Trauma","volume":"39","author":"Ogunbileje","year":"2017","journal-title":"J. Burn Care Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1093\/jbcr\/irx047","article-title":"The Effect of Burn Trauma on Lipid and Glucose Metabolism: Implications for Insulin Sensitivity","volume":"39","author":"Clayton","year":"2018","journal-title":"J. Burn Care Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1542\/peds.2007-1363","article-title":"Age Differences in Inflammatory and Hypermetabolic Postburn Responses","volume":"121","author":"Jeschke","year":"2008","journal-title":"Pediatrics"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1002\/ncp.10396","article-title":"High-Carbohydrate vs High-Fat Nutrition for Burn Patients","volume":"34","author":"Shields","year":"2019","journal-title":"Nutr. Clin. Pract."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.burns.2007.10.006","article-title":"Assessment of Muscle Function in Severely Burned Children","volume":"34","author":"Alloju","year":"2008","journal-title":"Burns"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/SHK.0b013e3181b92340","article-title":"Extent and magnitude of catecholamine surge in pediatric burned patients","volume":"33","author":"Kulp","year":"2010","journal-title":"Shock"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1002\/jcsm.13188","article-title":"Molecular Mechanisms of Post-Burn Muscle Wasting and the Therapeutic Potential of Physical Exercise","volume":"14","author":"Dombrecht","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/00024382-200207000-00008","article-title":"Activation of Stress-Responsive Pathways by the Sympathetic Nervous System in Burn Trauma","volume":"18","author":"Maass","year":"2002","journal-title":"Shock"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/SHK.0b013e3181af0494","article-title":"The role of hyperglycemia in burned patients: Evidence-based studies","volume":"33","author":"Mecott","year":"2010","journal-title":"Shock"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1210\/jc.2006-2158","article-title":"Urinary Cortisol and Catecholamine Excretion After Burn Injury in Children","volume":"93","author":"Norbury","year":"2008","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s41038-017-0089-5","article-title":"Sepsis in the Burn Patient: A Different Problem than Sepsis in the General Population","volume":"5","author":"Greenhalgh","year":"2017","journal-title":"Burns Trauma"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2633","DOI":"10.1016\/j.bbadis.2017.02.019","article-title":"The Biochemical Alterations Underlying Post-Burn Hypermetabolism","volume":"1863","author":"Auger","year":"2017","journal-title":"Biochim. Biophys. Acta BBA-Mol. Basis Dis."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Pin, F., Bonetto, A., Bonewald, L.F., and Klein, G.L. (2019). Molecular Mechanisms Responsible for the Rescue Effects of Pamidronate on Muscle Atrophy in Pediatric Burn Patients. Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00543"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/S0140-6736(16)31406-4","article-title":"Hypertrophic Scarring: The Greatest Unmet Challenge After Burn Injury","volume":"388","author":"Finnerty","year":"2016","journal-title":"Lancet"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"896821","DOI":"10.1155\/2013\/896821","article-title":"The Relationship between Cortisol and Bone Mineral Density in Competitive Male Cyclists","volume":"2013","author":"Mathis","year":"2013","journal-title":"J. Sports Med."},{"key":"ref_56","first-page":"707360","article-title":"The Potential Association of Later Initiation of Oral\/Enteral Nutrition on Euthyroid Sick Syndrome in Burn Patients","volume":"2013","author":"Rioja","year":"2013","journal-title":"Int. J. Endocrinol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1089\/thy.1997.7.125","article-title":"Euthyroid Sick Syndrome: An Overview","volume":"7","author":"McIVER","year":"1997","journal-title":"Thyroid"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1055\/s-0036-1583280","article-title":"Thyroid Hormone in the Pediatric Intensive Care Unit","volume":"05","author":"Radman","year":"2016","journal-title":"J. Pediatr. Intensive Care"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Barclay, C., Sedowofia, K., Thomson, M., and McIntosh, N. (1996). Thyroid hormones in burn injured children. Biochem. Soc. Trans., 24.","DOI":"10.1042\/bst024271s"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"124538","DOI":"10.1155\/2013\/124538","article-title":"Thyroid Hormone and Wound Healing","volume":"2013","author":"Safer","year":"2013","journal-title":"J. Thyroid Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1172\/JCI38793","article-title":"Resistance to Thyroid Hormone Is Associated with Raised Energy Expenditure, Muscle Mitochondrial Uncoupling, and Hyperphagia","volume":"120","author":"Mitchell","year":"2010","journal-title":"J. Clin. Investig."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Mathias, E., and Srinivas Murthy, M. (2017). Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects. Medicines, 4.","DOI":"10.20944\/preprints201711.0204.v1"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.bjae.2019.12.002","article-title":"Update on the Management of Burns in Paediatrics","volume":"20","author":"Suman","year":"2020","journal-title":"BJA Educ."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1152\/physrev.00030.2013","article-title":"Thyroid Hormone Regulation of Metabolism","volume":"94","author":"Mullur","year":"2014","journal-title":"Physiol. Rev."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1097\/01.ta.0000214580.27501.19","article-title":"Body Composition Changes with Time in Pediatric Burn Patients","volume":"60","author":"Przkora","year":"2006","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.jamcollsurg.2014.01.038","article-title":"Impact of Stress-Induced Diabetes on Outcomes in Severely Burned Children","volume":"218","author":"Finnerty","year":"2014","journal-title":"J. Am. Coll. Surg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1164\/rccm.201002-0190OC","article-title":"Intensive Insulin Therapy in Severely Burned Pediatric Patients: A Prospective Randomized Trial","volume":"182","author":"Jeschke","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1097\/BCR.0000000000000017","article-title":"Predictors of Insulin Resistance in Pediatric Burn Injury Survivors 24 to 36 Months Postburn","volume":"35","author":"Chondronikola","year":"2014","journal-title":"J. Burn Care Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1210\/jc.2008-1947","article-title":"Abnormal Insulin Sensitivity Persists up to Three Years in Pediatric Patients Post-Burn","volume":"94","author":"Gauglitz","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1001\/archsurg.1994.01420360091012","article-title":"Lipolysis in Burned Patients Is Stimulated by the \u03922-Receptor for Catecholamines","volume":"129","author":"Herndon","year":"1994","journal-title":"Arch. Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/00000658-199506000-00004","article-title":"Characterization of Growth Hormone Enhanced Donor Site Healing in Patients with Large Cutaneous Burns","volume":"221","author":"Herndon","year":"1995","journal-title":"Ann. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1517\/14656566.2012.738195","article-title":"Burns: An Update on Current Pharmacotherapy","volume":"13","author":"Rojas","year":"2012","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/TA.0000000000000594","article-title":"Predictors of Muscle Protein Synthesis After Severe Pediatric Burns","volume":"78","author":"Diaz","year":"2015","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1093\/jbcr\/irab225","article-title":"Physical, Psychological, and Social Outcomes in Pediatric Burn Survivors Ages 5 to 18 Years: A Systematic Review","volume":"43","author":"Patel","year":"2022","journal-title":"J. Burn Care Res."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1037\/rep0000116","article-title":"Social Competence in Pediatric Burn Survivors: A Systematic Review","volume":"62","author":"Szabo","year":"2017","journal-title":"Rehabil. Psychol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"R90","DOI":"10.1186\/cc6102","article-title":"Burn Size Determines the Inflammatory and Hypermetabolic Response","volume":"11","author":"Jeschke","year":"2007","journal-title":"Crit. Care"},{"key":"ref_77","first-page":"676","article-title":"Propranolol Does Not Increase Inflammation, Sepsis, or Infectious Episodes in Severely Burned Children","volume":"62","author":"Jeschke","year":"2007","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40272-020-00434-y","article-title":"The Management of Burn Pain in a Pediatric Burns-Specialist Hospital","volume":"23","author":"Storey","year":"2021","journal-title":"Pediatr. Drugs"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.burns.2013.11.024","article-title":"Play and Heal: Randomized Controlled Trial of DittoTM Intervention Efficacy on Improving Re-Epithelialization in Pediatric Burns","volume":"40","author":"Brown","year":"2014","journal-title":"Burns"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1186\/s13063-016-1346-9","article-title":"Effectiveness of Medical Hypnosis for Pain Reduction and Faster Wound Healing in Pediatric Acute Burn Injury: Study Protocol for a Randomized Controlled Trial","volume":"17","author":"Chester","year":"2016","journal-title":"Trials"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1097\/j.pain.0000000000001276","article-title":"Efficacy of Hypnosis on Pain, Wound-Healing, Anxiety, and Stress in Children with Acute Burn Injuries: A Randomized Controlled Trial","volume":"159","author":"Chester","year":"2018","journal-title":"Pain"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Boccella, S., De Filippis, L., Giorgio, C., Brandolini, L., Jones, M., Novelli, R., Amorizzo, E., Leoni, M.L.G., Terranova, G., and Maione, S. (2023). Combination Drug Therapy for the Management of Chronic Neuropathic Pain. Biomolecules, 13.","DOI":"10.3390\/biom13121802"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.burns.2005.12.006","article-title":"The Effectiveness of a Pain and Anxiety Protocol to Treat the Acute Pediatric Burn Patient","volume":"32","author":"Ratcliff","year":"2006","journal-title":"Burns"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1016\/j.burns.2015.05.024","article-title":"A Review of Community Management of Paediatric Burns","volume":"41","author":"Cox","year":"2015","journal-title":"Burns"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/BCR.0000000000000470","article-title":"Pain Management in Pediatric Burn Patients: Review of Recent Literature and Future Directions","volume":"38","author":"Pardesi","year":"2017","journal-title":"J. Burn Care Res."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"43","DOI":"10.4103\/0970-0358.70719","article-title":"Special Considerations in Paediatric Burn Patients","volume":"43","author":"Sharma","year":"2010","journal-title":"Indian J. Plast. Surg."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1097\/BCR.0000000000000007","article-title":"Outcomes of Outpatient Management of Pediatric Burns","volume":"35","author":"Brown","year":"2014","journal-title":"J. Burn Care Res."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1001\/archsurg.137.9.1049","article-title":"Effects of Delayed Wound Excision and Grafting in Severely Burned Children","volume":"137","year":"2002","journal-title":"Arch. Surg."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/S0022-3468(85)80039-7","article-title":"Early Excision of Major Burns in Children: Effect on Morbidity and Mortality","volume":"20","author":"Pietsch","year":"1985","journal-title":"J. Pediatr. Surg."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1097\/00004630-199409000-00005","article-title":"Management of Pediatric Facial Burns","volume":"15","author":"Housinger","year":"1994","journal-title":"J. Burn Care Rehabil."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1016\/j.burns.2017.07.025","article-title":"Eschar Removal by Bromelain Based Enzymatic Debridement (Nexobrid\u00ae) in Burns: An European Consensus","volume":"43","author":"Hirche","year":"2017","journal-title":"Burns"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1080\/00015458.2022.2068746","article-title":"Enzymatic Debridement: Past, Present, and Future","volume":"122","author":"Hoeksema","year":"2022","journal-title":"Acta Chir. Belg."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1111\/iwj.13405","article-title":"Rapid Enzymatic Burn Debridement: A Review of the Paediatric Clinical Trial Experience","volume":"17","author":"Shoham","year":"2020","journal-title":"Int. Wound J."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Korzeniowski, T., Grywalska, E., Stru\u017cyna, J., Bugaj-Tobiasz, M., Surowiecka, A., Korona-G\u0142owniak, I., Sta\u015bkiewicz, M., and Torres, K. (2022). Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164800"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1067\/msy.2001.116916","article-title":"Determinants of Blood Loss during Primary Burn Excision","volume":"130","author":"Hart","year":"2001","journal-title":"Surgery"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/archsurg.138.2.127","article-title":"Modulation of Inflammatory and Catabolic Responses in Severely Burned Children by Early Burn Wound Excision in the First 24 Hours","volume":"138","author":"Barret","year":"2003","journal-title":"Arch. Surg."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4103\/JCAS.JCAS_83_18","article-title":"Human Skin Allograft: Is It a Viable Option in Management of Burn Patients?","volume":"12","author":"Gupta","year":"2019","journal-title":"J. Cutan. Aesthetic Surg."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.1097\/01.CCM.0000285991.36698.E2","article-title":"Longitudinal Assessment of Integra in Primary Burn Management: A Randomized Pediatric Clinical Trial","volume":"35","author":"Branski","year":"2007","journal-title":"Crit. Care Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1097\/00006534-199904010-00006","article-title":"Outcome of Scalp Donor Sites in 450 Consecutive Pediatric Burn Patients","volume":"103","author":"Barret","year":"1999","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s00431-024-05916-6","article-title":"Comparison of the Effectiveness of Three Different Skin Substitutes for the Treatment of Pediatric Burns","volume":"184","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1089\/wound.2019.1089","article-title":"Negative Pressure Wound Therapy in Pediatric Burn Patients: A Systematic Review","volume":"10","author":"Pedrazzi","year":"2021","journal-title":"Adv. Wound Care"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4103\/2229-5151.100889","article-title":"Pediatric Burn Injuries","volume":"2","author":"Krishnamoorthy","year":"2012","journal-title":"Int. J. Crit. Illn. Inj. Sci."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0749-0704(18)30390-7","article-title":"Airway Management: Considerations in the Trauma Patient","volume":"6","author":"Grande","year":"1990","journal-title":"Crit. Care Clin."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"S500","DOI":"10.1097\/00003246-200211001-00015","article-title":"Burns","volume":"30","author":"Sheridan","year":"2002","journal-title":"Crit. Care Med."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.yapd.2009.08.020","article-title":"Advances in the Care of Children with Burns","volume":"56","author":"Fabia","year":"2009","journal-title":"Adv. Pediatr."},{"key":"ref_106","first-page":"17","article-title":"Evaluating and Managing Burn Wounds","volume":"12","author":"Sheridan","year":"2000","journal-title":"Dermatol. Nurs."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s41038-017-0070-3","article-title":"Epidemiology of Isolated Foot Burns in Children Presenting to a Queensland Paediatric Burns Centre\u2014A Two-Year Study in Warmer Climate","volume":"5","author":"Ngu","year":"2017","journal-title":"Burns Trauma"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/0305-4179(88)90225-2","article-title":"Surgical Correction of Burn Scar Contractures of the Foot in Children","volume":"14","author":"Waymack","year":"1988","journal-title":"Burns"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1097\/00005373-199509000-00026","article-title":"Tangential Excision and Skin Grafting for Ash Burns of the Foot in Children: A Preliminary Report","volume":"39","author":"Singh","year":"1995","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1093\/jbcr\/irac036","article-title":"Safety and Benefits of Intraoperative Enteral Nutrition in Critically Ill Pediatric Burn Patients: A Systematic Review and Pooled Analysis","volume":"43","author":"Hudson","year":"2022","journal-title":"J. Burn Care Res."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"54","DOI":"10.21037\/jeccm.2018.05.11","article-title":"Nutritional Therapy for Burns in Children","volume":"2","author":"Galfo","year":"2018","journal-title":"J. Emerg. Crit. Care Med."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/MCC.0b013e32834c563f","article-title":"Burn Management","volume":"17","author":"Endorf","year":"2011","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1093\/jbcr\/iraa129","article-title":"Why Delay? Early Enteral Nutrition in Pediatric Burn Patients Improves Outcomes","volume":"42","author":"Shahi","year":"2021","journal-title":"J. Burn Care Res."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"393","DOI":"10.5935\/0103-507X.20190062","article-title":"Pediatric Enteral Nutrition Therapy for Burn Victims: When Should It Be Initiated?","volume":"31","author":"Valentini","year":"2019","journal-title":"Rev. Bras. Ter. Intensiv."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1002\/ncp.10399","article-title":"Safety and Tolerance of Intraoperative Enteral Nutrition Support in Pediatric Burn Patients","volume":"34","author":"Sunderman","year":"2019","journal-title":"Nutr. Clin. Pract."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.burns.2017.07.019","article-title":"Safety and Efficacy of Uninterrupted Perioperative Enteral Feeding in Pediatric Burn Patients","volume":"44","author":"Imeokparia","year":"2018","journal-title":"Burns"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"s41038-015-0004\u2013x","DOI":"10.1186\/s41038-015-0004-x","article-title":"Nutrition and Metabolism in the Rehabilitative Phase of Recovery in Burn Children: A Review of Clinical and Research Findings in a Speciality Pediatric Burn Hospital","volume":"3","author":"Prelack","year":"2015","journal-title":"Burns Trauma"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"e120","DOI":"10.1097\/PCC.0b013e3182712b2b","article-title":"The Safety and Efficacy of Parenteral Nutrition Among Pediatric Patients with Burn Injuries","volume":"14","author":"Dylewksi","year":"2013","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"e83","DOI":"10.1016\/j.jss.2010.10.006","article-title":"Association Between Dietary Fat Content and Outcomes in Pediatric Burn Patients","volume":"166","author":"Lee","year":"2011","journal-title":"J. Surg. Res."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.nut.2008.10.011","article-title":"Nutritional Therapy for Burns in Children and Adults","volume":"25","author":"Chan","year":"2009","journal-title":"Nutrition"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/BF02067118","article-title":"Nutritional Support of the Burned Patient","volume":"16","author":"Waymack","year":"1992","journal-title":"World J. Surg."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.clnu.2013.02.012","article-title":"ESPEN Endorsed Recommendations: Nutritional Therapy in Major Burns","volume":"32","author":"Rousseau","year":"2013","journal-title":"Clin. Nutr."},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"(2013). The Utility of Long-Term Propranolol in Pediatric Burn Patients. AAP Grand Rounds, 29, 20.","DOI":"10.1542\/gr.29-2-20"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"104","DOI":"10.54847\/cp.2022.03.12","article-title":"Advances in the Treatment of Burned Children","volume":"35","year":"2022","journal-title":"Cir. Pedi\u00e1trica"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.burns.2004.08.006","article-title":"Effects of Growth Hormone on Anthropometric Measurements and Cardiac Function in Children with Thermal Injury","volume":"31","author":"Mlcak","year":"2005","journal-title":"Burns"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/00000658-199905000-00014","article-title":"Muscle Protein Catabolism After Severe Burn: Effects of IGF-1\/IGFBP-3 Treatment","volume":"229","author":"Herndon","year":"1999","journal-title":"Ann. Surg."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/01.sla.0000180398.70103.24","article-title":"Metabolic and Hormonal Changes of Severely Burned Children Receiving Long-Term Oxandrolone Treatment","volume":"242","author":"Przkora","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/SLA.0b013e318146980e","article-title":"The Effect of Oxandrolone on the Endocrinologic, Inflammatory, and Hypermetabolic Responses During the Acute Phase Postburn","volume":"246","author":"Jeschke","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.jamcollsurg.2011.12.038","article-title":"Five-Year Outcomes after Oxandrolone Administration in Severely Burned Children: A Randomized Clinical Trial of Safety and Efficacy","volume":"214","author":"Porro","year":"2012","journal-title":"J. Am. Coll. Surg."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1002\/jbmr.2162","article-title":"Pamidronate Attenuates Muscle Loss After Pediatric Burn Injury","volume":"29","author":"Herndon","year":"2014","journal-title":"J. Bone Miner. Res."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"E232","DOI":"10.1152\/ajpendo.00194.2017","article-title":"Short-Term Metformin and Exercise Training Effects on Strength, Aerobic Capacity, Glycemic Control, and Mitochondrial Function in Children with Burn Injury","volume":"314","author":"Rivas","year":"2018","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.burnso.2017.09.003","article-title":"Thyroid Storm in a Pediatric High Voltage Electrical Burn Injury","volume":"2","author":"Sen","year":"2018","journal-title":"Burns Open"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1177\/0148607115587948","article-title":"Clinical Trial of Vitamin D2 vs D3 Supplementation in Critically Ill Pediatric Burn Patients","volume":"41","author":"Gottschlich","year":"2017","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_134","doi-asserted-by":"crossref","unstructured":"Jeschke, M.G., Williams, F.N., Finnerty, C.C., Rodriguez, N.A., Kulp, G.A., Ferrando, A., Norbury, W.B., Suman, O.E., Kraft, R., and Branski, L.K. (2012). The Effect of Ketoconazole on Post-Burn Inflammation, Hypermetabolism and Clinical Outcomes. 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