Abstract and Introduction
Abstract
Self-injection of growth hormone (GH) by children with GH deficiency can be problematic. They may have difficulty manipulating injection devices or preparing medication, and injections can be painful and create anxiety. Adherence to daily GH injections optimizes treatment benefit. Studies indicate that injection pens or needle-free devices enable easy self-injection by children, minimize medication reconstitution and storage requirements, and reduce injection pain. Newer GH delivery devices potentially encourage improved patient adherence. Reviewing features of GH devices will help nurses decide which GH device best fits the needs and abilities of pediatric patients. We searched recent medical literature about GH device development, about device-associated patient preferences and treatment adherence, and comparisons among GH devices. We concluded that improved awareness of the strengths and limitations of GH devices will enable nurses to guide families in selecting and using GH devices, improving adherence and outcomes, and helping children reach full growth potential.
Introduction
Growth hormone deficiency (GHD) was initially treated in the 1950s with growth hormone (GH) extract ed from human pituitary glands. Recombinant forms of GH became available in the 1980s, produced by either genetically engineered Escherichia coli (E. coli) or a mammalian cell-derived re combinant form using murine C127 cells (Flodh, 1986; Zeisel, von Petrykowski, & Wais, 1992). The unlimited availability of recombinant GH allowed the expansion of treatment for GH-related disorders. The etiology of GH-related disorders in children is varied, and FDA-approved pediatric GH treatment indications currently include GHD, small for gestational age (SGA) without catch-up growth, idiopathic short stature, Turner syndrome with short stature, Noonan syndrome with short stature, Prader-Willi syndrome (PWS) with short stature, short stature homeobox-containing gene (SHOX) deficiency, and poor growth due to chronic renal insufficiency (Franklin & Geffner, 2009). GH treatment becomes part of a child's treatment plan when growth failure is recognized. For optimal outcomes, referral to a pediatric endocrinologist should occur early, and children may receive GH treatment from as young as infancy through teenage years.
Patient adherence to the daily GH treatment regimen is needed for optimal treatment benefit, and GH delivery devices have evolved to support improved patient adherence. GH delivery devices have progressed from conventional syringe/vials to include injector pens, an electronic injector, and needle-free injectors. Goals underlying GH device development include the simplification of drug delivery and reduction of injection anxiety and anticipated pain. Ad herence is a central issue because lower adherence to GH injections has been associated with significantly lower height velocities (Desrosiers, O'Brien, & Blethen, 2005; Kapoor et al., 2008). Device characteristics that may contribute to low adherence include greater handling complexity, storage and preparation requirements that interfere with the patient's daily routine, poor ease of use, low reliability and accuracy, and injection pain (Haverkamp et al., 2008; Kirk, 2010). GH devices are reviewed, focusing on features that may optimize ease of use and patient adherence while providing device feature comparisons to assist nursing staff in the selection of the GH device best suited to their patients' needs and abilities.
Pediatr Nurs. 2015;41(2):72-77. © 2015 Jannetti Publications, Inc.
