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Silva DCGD, Cunha MDSBD, Santana ADO, Alves AMDS, Santos MP. Nutritional interventions in children and adolescents with cerebral palsy: systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2022107. [PMID: 37436239 DOI: 10.1590/1984-0462/2024/42/2022107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/05/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). DATA SOURCE This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde - Lilacs, Embase, United States National Library of Medicine - PubMed, Scientific Electronic Library Online - SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. DATA SYNTHESIS Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. CONCLUSIONS Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.
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Popescu M, Mutalib M. Rate of paediatric gastrostomy insertion in England and relationship to epidemiology of cerebral palsy. Frontline Gastroenterol 2023; 14:399-406. [PMID: 37581183 PMCID: PMC10423607 DOI: 10.1136/flgastro-2022-102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/24/2023] [Indexed: 08/16/2023] Open
Abstract
Background and objectives Gastrostomy tubes are commonly used to provide an alternative route for enteral nutrition. Most of the gastrostomies are inserted in children with cerebral palsy. Previous studies have shown an increase in insertion rate, however, epidemiological studies reveal a stasis in prevalence of cerebral palsy. We aimed to provide an up-to-date rate of gastrostomy insertion in children in England over a 20-year period and systematically review the prevalence of cerebral palsy to ascertain an epidemiological explanation for insertion trends. Methods Retrospective search of Hospital Episode Statistic, a database held diagnosis and procedural code from all England National Health Service hospitals from 2000 to 2021 using International Classification of Disease-10 and Office of Population Censuses and Survey's Classification-4. England Office for National Statistics data were used for population census. MEDLINE and EMBASE were systematically searched for epidemiology of cerebral palsy. Results There were 23 079 gastrostomies inserted in children <15 years in England (2000-2021) leading to a frequency of 12.4 insertions per 100 000 children per year and 1383 gastrostomy insertions in 15-18 years age group (6 per 100 000). The overall gastrostomy insertion rate in children <15 years has increased from 3.7 procedures per 100 000 in 2000 to 18.3 per 100 000 in 2017. Prevalence of cerebral palsy remained stable (1.5-3.3 per 1000 birth) since 1985. Conclusions There was a significant increase in the rate of gastrostomy insertion in children in England during most of the last 20 years not explained by a stable prevalence of cerebral palsy.
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Affiliation(s)
- Mara Popescu
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mohamed Mutalib
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Evelina London Children's Hospital, London, UK
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Trovato CM, Capriati T, Bolasco G, Brusco C, Santariga E, Laureti F, Campana C, Papa V, Mazzoli B, Corrado S, Tambucci R, Maggiore G, Diamanti A. Enteral formula compared to Nissen-Fundoplication: Data from a retrospective analysis on tolerance, utility, applicability, and safeness in children with neurological diseases. Front Nutr 2023; 10:1093218. [PMID: 36969827 PMCID: PMC10034170 DOI: 10.3389/fnut.2023.1093218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives and studyApproximately 46–90% of children with neurological disorders (NDs) suffer from gastrointestinal diseases, such as gastro-esophageal reflux disease (GERD), constipation, or malnutrition. Therefore, enteral feeding is often necessary to achieve nutritional requirements. The treatment of GERD could be based on pharmacological therapy, nutritional treatment (changing the type of formula), or surgical treatment (Nissen Fundoplication, NF). The aim of this study was to describe and compare resource consumption between NE based on different formulas and NF in patients with ND.MethodsWe performed a retrospective analysis on all children with neurological damage (age: 29 days−17 years) treated from January 2009 to January 2019 due to nutritional problems and food and/or gastrointestinal intolerances. For all patients, demographic and anthropometric characteristics, symptoms, type of nutrition (formula and enteral access), and number and type of outpatient or emergency room visits were collected. Patients with <24 months of age at the closing of the database and with <24 months of follow-up were excluded.ResultsOut of 376 children, 309 children (M: 158; median age: 4 IQR 1–10) were enrolled, among which, 65 patients (NF group M: 33; median age: 5.3 IQR 1.8–10.7) underwent NF. Vomit, GERD, and dysphagia were more represented in the NF group (p < 0.05). Our analysis shows that the NF group seems to present a lower number of hospitalization and a lower number of visits for non-GI disorders, but a higher number of visits for GI disorders compared to non-NF. In the NF group, a higher prevalence of the use of amino-acid-based formula and free diet is observed, with a trend for the lower prevalence of casein-based or whey+casein-based formula (Fisher test p = 0.072). The median cost of a patient enrolled in the database is € 19,515 ± 540 ($ 20,742.32 ± 573.96) per year, with no significant difference between the two groups. Regarding formula, at baseline, 76 children consumed a free diet, 24 a casein-based formula, 139 a whey+casein-based formula, 46 a whey-based formula, and 24 an amino-acid-based formula.ConclusionsIn conclusion, compared to EN, NF may not improve the clinical aspect and related costs in children with NDs. Considering the psychological and QoL burden for patients, in a “step-up” strategy, EN could be proposed as an efficient alternative to NF.
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Affiliation(s)
- Chiara Maria Trovato
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Teresa Capriati
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Giulia Bolasco
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Carla Brusco
- Administrative Management, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Emma Santariga
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Laureti
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Carmen Campana
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Valentina Papa
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Bianca Mazzoli
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Corrado
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Tambucci
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Giuseppe Maggiore
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Diamanti
- Gastroenterology and Nutritional Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Bambino Gesù Children's Hospital, Rome, Italy
- *Correspondence: Antonella Diamanti
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Diamanti A, Capriati T, Mosca A, Trovato CM, Laureti F, Mazzoli B, Bolasco G, Caldaro T, De Peppo F, Staccioli S, Papa RE, Cerchiari A, De Angelis P, Maggiore G. Neurological impairment and malnutrition in children: The role of home enteral nutrition in real life. Front Nutr 2023; 10:1087603. [PMID: 37032763 PMCID: PMC10073451 DOI: 10.3389/fnut.2023.1087603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/17/2023] [Indexed: 04/11/2023] Open
Abstract
Objective Recent decades have brought an increased survival of children with Neurologic Impairment (NI) but malnutrition and digestive comorbidity remain important challenges to face. We designed the present study to assess the course of nutritional status following standardized Home Enteral Nutrition (HEN) program and to evaluate impact of changing mode of feeding, as a part of overall multidisciplinary management, on digestive co-morbidity as Gastro-Esophageal Reflux Disease (GERD), Oropharyngeal Dysphagia (OPD), constipation and airway aspiration. Methods We performed a retrospective analysis on NI children entered into Institutional HEN program due to NI disorders between January 2011 and 2019. Demographic, anthropometric characteristics (BMI z-score and weight for age z-score) and symptoms (GERD, OPD constipation and airway aspiration) were collected at the enrolment and during the follow up. Results We enrolled 402 patients (median age: 39 months); overall survival was 97%. Nutritional status was significantly improved by HEN; in particular growth profile significantly changed within the first 2 years following HEN beginning; GERD and airways aspirations decreased after HEN beginning. Constipation and OPD remained unchanged over time. Conclusions Malnutrition and digestive complaints are distinctive features of NI children. Nutritional status improve after 2 years from the beginning of standardized nutritional interventions. Overall multidisciplinary care, including standardized HEN protocols, seems to also impact on GERD and airway aspirations, which can decrease over time. It is possible that constipation and OPD, unchanged over time, are more dependent on underlying diseases than on overall treatments.
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Affiliation(s)
- Antonella Diamanti
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Antonella Diamanti
| | - Teresa Capriati
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Antonella Mosca
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Chiara Maria Trovato
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Laureti
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Bianca Mazzoli
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giulia Bolasco
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Tamara Caldaro
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco De Peppo
- Unit of Palidoro Pediatric Surgery, Department of Specialized Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Susanna Staccioli
- Department of Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Raffaele Edo Papa
- Pediatrics Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Cerchiari
- Department of Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paola De Angelis
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giuseppe Maggiore
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Batra A, Marino LV, Beattie RM. Feeding children with neurodisability: challenges and practicalities. Arch Dis Child 2022; 107:967-972. [PMID: 35105542 DOI: 10.1136/archdischild-2021-322102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/13/2022] [Indexed: 12/25/2022]
Abstract
Nutritional management for children with neurodisability can be challenging and there are an increasing number of children at risk of malnutrition. Management involves healthcare professionals in community and hospital working together with the family with the aim of optimising nutrition and quality of life. Feeding difficulties can be the result of physical causes like lack of oromotor coordination, discomfort associated with reflux oesophagitis or gastrointestinal dysmotility. Non-physical causes include parental/professional views towards feeding, altered perception of pain and discomfort, extreme sensitivity to certain textures and rigidity of feeding schedule associated with artificial feeding. Estimating nutritional needs can be difficult and is affected by comorbidities including epilepsy and abnormal movements, severity of disability and mobility. Defining malnutrition is difficult as children with neurodisability reflect a wide spectrum with disparate growth patterns and body composition and auxology is less reliable and less reproducible. Management involves selecting the type and method of feeding best suited for the patient. As artificial feeding can place a significant burden of care any decision-making should be, as much as possible, in concurrence with the family. Symptom management sometimes requires pharmacological interventions, but polypharmacy is best avoided. The article aims to discuss the pathways of identifying children at risk of malnutrition and available management options with a strong emphasis on working as a clinical team with the child and family.
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Affiliation(s)
- Akshay Batra
- Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - R Mark Beattie
- Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Jahan I, Sultana R, Muhit M, Akbar D, Karim T, Al Imam MH, Das MC, Smithers-Sheedy H, McIntyre S, Badawi N, Khandaker G. Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review. Nutrients 2022; 14:nu14061211. [PMID: 35334869 PMCID: PMC8951851 DOI: 10.3390/nu14061211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Malnutrition is substantially higher among children with cerebral palsy (CP) in low- and middle-income countries (LMICs) when compared with the general population. Access to appropriate interventions is crucial for better management of malnutrition and nutritional outcomes of those children. We aimed to review the existing evidence on nutrition interventions for children with CP in LMICs. Methods: Online databases, i.e., PubMed and Scopus, and Google Scholar were searched up to 10 January 2022, to identify peer-reviewed publications/evidence on LMIC focused nutritional management guidelines/interventions. Following title screening and abstract review, full articles that met the inclusion/exclusion criteria were retained for data charting. Information about the study characteristics, nutrition interventions, and their effectiveness were extracted. Descriptive data were reported. Results: Eight articles published between 2008 and 2019 were included with data from a total of n = 252 children with CP (age range: 1 y 0 m–18 y 7 m, 42% female). Five studies followed experimental design; n = 6 were conducted in hospital/clinic/center-based settings. Four studies focused on parental/caregiver training; n = 2 studies had surgical interventions (i.e., gastrostomy) and n = 1 provided neurodevelopmental therapy feeding intervention. Dietary modification as an intervention (or component) was reported in n = 5 studies and had better effect on the nutritional outcomes of children with CP compared to interventions focused on feeding skills or other behavioral modifications. Surgical interventions improved nutritional outcomes in both studies; however, none documented any adverse consequences of the surgical interventions. Conclusion: There is a substantial knowledge gap on nutrition interventions for children with CP in LMICs. This hinders the development of best practice guidelines for the nutritional management of children with CP in those settings. Findings suggest interventions directly related to growth/feeding of children had a better outcome than behavioral interventions. This should be considered in planning of nutrition-focused intervention or comprehensive services for children with CP in LMICs.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Risad Sultana
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, QLD 4701, Australia;
| | - Tasneem Karim
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2145, Australia
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
- Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Westmead, NSW 2145, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2145, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
- Correspondence: ; Tel.: +61-7-49206989
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Carman KB, Aydın K, Kilic Aydin B, Cansu A, Direk MC, Durmus S, Dündar NO, Gencpinar P, Gungor S, Gurkas E, Hur O, Karadag M, Karademir CN, Ozkan Kart P, Okuyaz C, Oz NA, Peduk Y, Per H, Serin MH, Tekgul H, Unay B, Yarar C, Yildirim GK. Evaluation of micronutrient levels in children with cerebral palsy. Pediatr Int 2022; 64:e15005. [PMID: 34585809 DOI: 10.1111/ped.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/08/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies evaluating the nutritional status of children with cerebral palsy (CP) have focused on energy requirements and protein intake. The present work aimed to assess nutritional status and micronutrient levels of children with (CP). METHODS This multicenter, cross-sectional and observational study was conducted in 10 different cities in Turkey. Data were available for 398 participants. Anthropometric measurements, feeding mode, nutritional status, and micronutrient levels were evaluated. RESULTS The study was conducted with 398 participants (303 patients and 95 healthy controls). Statistical analysis showed that according to the Gomez Classification, weight-for-age (WFA) revealed malnutrition in 92.6% of children with CP, based on Centers for Disease Control and Prevention percentiles. Measurements of micronutrient levels showed that zinc levels were low in patients, whereas vitamin A levels were low in controls. Phosphorous and manganese levels were significantly lower in malnourished children than in typical children. The results revealed that children consuming enteral nutrition solutions had higher selenium and lower zinc levels than non-consumers. CONCLUSIONS Malnutrition is not only a protein- or calorie-based problem; micronutrient deficiencies might cause severe health problems. Children with chronic neurological disabilities must be carefully evaluated for these issues. Therefore, nutritional interventions should be adapted to nutrition.
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Affiliation(s)
- Kursat Bora Carman
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Kursad Aydın
- Department of Pediatric Neurology, Medipol University, Istanbul, Turkey
| | - Betul Kilic Aydin
- Department of Pediatric Neurology, Medipol University, Istanbul, Turkey
| | - Ali Cansu
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
| | | | - Selver Durmus
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | - Nihal Olgaç Dündar
- Department of Pediatric Neurology, Katip Celebi University, Izmir, Turkey
| | - Pinar Gencpinar
- Department of Pediatric Neurology, Katip Celebi University, Izmir, Turkey
| | - Serdal Gungor
- Department of Pediatric Neurology, Inonu University, Malatya, Turkey
| | - Esra Gurkas
- Departments of Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Ozgen Hur
- Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Meral Karadag
- Department of Pediatric Neurology, Inonu University, Malatya, Turkey
| | - Cefa Nil Karademir
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Pinar Ozkan Kart
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | - Nefise Arıbas Oz
- Departments of Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Yakup Peduk
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | - Huseyin Per
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | | | - Hasan Tekgul
- Department of Pediatric Neurology, Ege University, Izmir, Turkey
| | - Bulent Unay
- Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Coskun Yarar
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Gonca Kilic Yildirim
- Pediatric Metabolic Diseases and Nutrition, Eskisehir Osmangazi University, Eskisehir, Turkey
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Obesity and cardio-metabolic risk factors among children and adolescents with cerebral palsy. NUTR HOSP 2020; 37:685-691. [PMID: 32686452 DOI: 10.20960/nh.03009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: obesity and associated cardiometabolic complications are increasing among adults with cerebral palsy (CP). Information in children is scarce, and there is no consensus definition of obesity. Objectives: to describe the frequency of obesity and metabolic complications in children and adolescents with CP. Methods: a descriptive, cross-sectional study performed in two outpatient pediatric special needs centers. Demographic, anthropometric (Brooks 2011), and motor function (GMFCS) data, as well as antiepileptic use, were recorded. Fasting triglycerides (TG), total cholesterol (TC), vitamin D (25OHD), glycemia (GLY), and insulinemia levels were measured. The HOMA index was calculated. Results: sixty-five patients were enrolled. Aage was 10.8 ± 4.9 years; 63.1 % were male; 81.6 % had GMFCS IV-V; 43.5 % had a gastrostomy; and 83.1 % were on antiepileptics. According to their BMI, 15.4 % were underweight (< 10th percentile) and 10.8 % overweight (> 75th percentile). Overall, 6.1 % had TC ≥ 200 mg/dL, 21.4 % had TG ≥ 110 or 130 mg/dL, 4.6 % had GLY ≥ 100 mg/dL, 16.9 % had HOMA ≥ 3, and 76.9 % had 25OHD < 30 ng/mL. Children with BMI ≥ 75th percentile had higher HOMA and insulin resistance rates than those with BMI < 75th percentile. Elevated TGs were associated with high motor impairment and low vitamin D. HOMA was associated to feminine gender and BMI ≥ 75th percentile. Conclusions: the frequency of cardiometabolic risk factors was high in this sample of pediatric patients with CP, associated with overweight, low mobility, and vitamin D deficiency. We propose a BMI > 75th percentile as cutoff point for metabolic risk factors.
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Bertoncelli CM, Altamura P, Vieira ER, Bertoncelli D, Latalski M, Berthet S, Solla F. Predictive Model for Gastrostomy Placement in Adolescents With Developmental Disabilities and Cerebral Palsy. Nutr Clin Pract 2019; 35:149-156. [DOI: 10.1002/ncp.10309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Carlo M. Bertoncelli
- Department of Pediatric Surgery; Lenval University Children's Hospital of Nice; Nice France
- EEAP H Germain; Fondation Lenval - Children Hospital; Nice France
| | - Paola Altamura
- Department of Medicinal Chemistry and Pharmaceutical Technology; University of Chieti; Chieti Italy
| | - Edgar Ramos Vieira
- Department of Physical Therapy; Florida International University; Miami Florida USA
| | - Domenico Bertoncelli
- Department of Information Engineering; Computer Science and Mathematics; University of L'Aquila; L'Aquila Italy
| | - Michal Latalski
- Children Orthopedic Department; Children University Hospital of Lublin; Lublin Poland
| | - Stéphanie Berthet
- Pediatric Gastroenterology Unit; Lenval University Children's Hospital of Nice; Nice France
| | - Federico Solla
- Department of Pediatric Surgery; Lenval University Children's Hospital of Nice; Nice France
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10
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Neelis E, Kouwenhoven S, Olieman J, Tabbers M, Jonkers C, Wells J, Fewtrell M, Wijnen R, Rings E, de Koning B, Hulst J. Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long-Term Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2019; 44:318-326. [PMID: 30900272 DOI: 10.1002/jpen.1527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/17/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children with intestinal failure (IF) are at risk of growth failure, but little information about body composition is available. Our aim was to assess body composition using air displacement plethysmography (ADP) and relate it to clinical and growth parameters. METHODS In this prospective descriptive observational 2-center cohort study, children aged 2-18 years receiving home parenteral nutrition (PN) for ≥6 months underwent ADP measurement. Fat mass index (FMI) and fat-free mass index (FFMI) standard deviation scores (SDSs) were calculated to normalize for small body size. RESULTS Twenty-one out of 22 children, median age 7.4 years, underwent successful ADP measurement after a median PN duration of 5.5 years. They were significantly lighter (median weight for age SDS -0.71, P = 0.004) and shorter (median height for age SDS -1.55, P < 0.001) than the normal population mean; 52% were growing below target height range. They had low FFMI (median SDS -1.53, P < 0.001) and high FMI (median SDS 0.80, P = 0.002). Weight for height and body mass index (BMI) were significantly associated with FFMI and BMI with FMI, but children with the same weight and height showed different body composition. In 13 patients with 1-year follow-up, growth and body composition did not change significantly. CONCLUSION Children with IF receiving long-term PN show lower FFM and higher FM than healthy children. Additionally, children with similar routine growth parameters showed different body composition. Further studies should evaluate the effect of a patient-tailored approach including physical activity and nutrition advice based on body composition.
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Affiliation(s)
- Esther Neelis
- Department of Pediatric Gastroenterology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Stefanie Kouwenhoven
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Joanne Olieman
- Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Dietetics, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Merit Tabbers
- Department of Pediatric Gastroenterology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Cora Jonkers
- Department of Dietetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jonathan Wells
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - René Wijnen
- Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Edmond Rings
- Department of Pediatric Gastroenterology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatric Gastroenterology, Leiden University Medical Center - Willem Alexander Children's Hospital, Leiden, the Netherlands
| | - Barbara de Koning
- Department of Pediatric Gastroenterology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jessie Hulst
- Department of Pediatric Gastroenterology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
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11
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Caramico-Favero DCO, Guedes ZCF, Morais MBD. FOOD INTAKE, NUTRITIONAL STATUS AND GASTROINTESTINAL SYMPTOMS IN CHILDREN WITH CEREBRAL PALSY. ARQUIVOS DE GASTROENTEROLOGIA 2019; 55:352-357. [PMID: 30785518 DOI: 10.1590/s0004-2803.201800000-78] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cerebral palsy may be associated with comorbidities such as undernutrition, impaired growth and gastrointestinal symptoms. Children with cerebral palsy exhibit eating problems due to the effect on the anatomical and functional structures involved in the eating function resulting in malnutrition. OBJECTIVE The aim of this study was to investigate the association between food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy. METHODS Cross-sectional study that included 40 children with cerebral palsy (35 with spastic tetraparetic form and 5 with non-spastic choreoathetoid form of cerebral palsy, all requiring wheelchairs or bedridden) aged from 4 to 10 years. The dietary assessment with the parents was performed using the usual household food intake inquiry. Anthropometric data were collected. Gastrointestinal symptoms associated with deglutition disorders, gastroesophageal reflux and chronic constipation were also recorded. RESULTS The median of height-for-age Z-score (-4.05) was lower (P<0.05) than the median of weight-for-age (-3.29) and weight-for-height (-0.94). There was no statistical difference between weight-for-age and weight-for-height Z-scores. Three patients with cerebral palsy (7.5%) exhibited mild anemia, with normal ferritin levels in two. Symptoms of dysphagia, gastroesophageal reflux, and constipation were found in 82.5% (n=33), 40.0% (n=16), and 60.0% (n=24) of the sample, respectively. The patients with symptoms of dysphagia exhibited lower daily energy (1280.2±454.8 Kcal vs 1890.3±847.1 Kcal, P=0.009), carbohydrate (median: 170.9 g vs 234.5 g, P=0.023) and fluid intake (483.1±294.9 mL vs 992.9±292.2 mL, P=0.001). The patients with symptoms of gastrointestinal reflux exhibited greater daily fluid intake (720.0±362.9 mL) than the patients without symptoms of gastroesophageal reflux (483.7±320.0 mL, P=0.042) and a greater height-for-age deficit (Z-score: -4.9±1.7 vs 3.7±1.5, P=0.033). The patients with symptoms of constipation exhibited lower daily dietary fiber (9.2±4.3 g vs 12.3±4.3 g, P=0.031) and fluid (456.5±283.1 mL vs 741.1±379.2 mL, P=0.013) intake. CONCLUSION Children with cerebral palsy exhibited wide variability in food intake which may partially account for their severe impaired growth and malnutrition. Symptoms of dysphagia, gastroesophageal reflux, and constipation are associated with different food intake patterns. Therefore, nutritional intervention should be tailored considering the gastrointestinal symptoms and nutritional status.
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Affiliation(s)
| | | | - Mauro Batista de Morais
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brasil
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12
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Hauer J. Feeding Intolerance in Children with Severe Impairment of the Central Nervous System: Strategies for Treatment and Prevention. CHILDREN-BASEL 2017; 5:children5010001. [PMID: 29271904 PMCID: PMC5789283 DOI: 10.3390/children5010001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/21/2022]
Abstract
Children with severe impairment of the central nervous system (CNS) experience gastrointestinal (GI) symptoms at a high rate and severity, including retching, vomiting, GI tract pain, and feeding intolerance. Commonly recognized sources of symptoms include constipation and gastroesophageal reflux disease. There is growing awareness of sources due to the impaired nervous system, including visceral hyperalgesia due to sensitization of sensory neurons in the enteric nervous system and central neuropathic pain due to alterations in the thalamus. Challenging the management of these symptoms is the lack of tests to confirm alterations in the nervous system as a cause of symptom generation, requiring empirical trials directed at such sources. It is also common to have multiple reasons for the observed symptoms, further challenging management. Recurrent emesis and GI tract pain can often be improved, though in some not completely eliminated. In some, this can progress to intractable feeding intolerance. This comprehensive review provides an evidence-based approach to care, a framework for recurrent symptoms, and language strategies when symptoms remain intractable to available interventions. This summary is intended to balance optimal management with a sensitive palliative care approach to persistent GI symptoms in children with severe impairment of the CNS.
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Affiliation(s)
- Julie Hauer
- Boston Children's Hospital, Division of General Pediatrics, Harvard School of Medicine, 300 Longwood Ave, Boston, MA 02115, USA.
- Seven Hills Pediatric Center, 22 Hillside, Groton, MA 01450, USA.
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13
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Wright CM, Reynolds L, Ingram E, Cole TJ, Brooks J. Validation of US cerebral palsy growth charts using a UK cohort. Dev Med Child Neurol 2017; 59:933-938. [PMID: 28656704 DOI: 10.1111/dmcn.13495] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/27/2022]
Abstract
AIM Growth charts for cerebral palsy (CP) have been constructed using data for 24 920 Californian patients, covering ages 2 to 20 years, with separate charts for the five severity levels of the Gross Motor Function Classification System (GMFCS). Our aim was to test how the data for British children with CP fit these charts, compared with conventional local charts. METHOD US CP growth reference was reanalysed using the lambda-mu-sigma (LMS) method to allow calculation of standard deviation z-scores. Growth data for 195 children with CP in Glasgow, UK, were retrieved and converted to z-scores using the CP reference as well as the combined World Health Organization and UK 1990 growth reference (UK-WHO). RESULTS Compared to the UK-WHO reference, measurements diverged progressively with increasing severity, with mean height for GMFCS level V being close to the second UK-WHO centile. Compared with the CP reference, mean height and weight z-scores were between the 50th and 75th centiles for all severity levels, while body mass index was just below the 50th centile. INTERPRETATION British children with severe CP seem relatively very small when their growth data are plotted on non-CP charts, but their data for weight and body mass index fit well to US CP charts and reasonably well for height. The LMS look-up tables will make it possible to calculate z-scores and produce charts in local formats.
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Affiliation(s)
- Charlotte M Wright
- Department of Child Health, MVLS College, University of Glasgow, Glasgow, UK
| | - Lucy Reynolds
- Specialist Children's Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Emily Ingram
- Department of Child Health, MVLS College, University of Glasgow, Glasgow, UK
| | - Tim J Cole
- Department of Life Course Epidemiology and Biostatistics, Great Ormond Street Institute of Child Health, University College, London, UK
| | - Jordan Brooks
- Life Expectancy Project, San Francisco, California, USA
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14
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European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment. J Pediatr Gastroenterol Nutr 2017; 65:242-264. [PMID: 28737572 DOI: 10.1097/mpg.0000000000001646] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment. METHODS Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.
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15
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Hauer J, Houtrow AJ, Feudtner C, Klein S, Klick J, Linebarger J, Norwood KW, Adams RC, Brei TJ, Davidson LF, Davis BE, Friedman SL, Hyman SL, Kuo DZ, Noritz GH, Yin L, Murphy NA. Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System. Pediatrics 2017; 139:peds.2017-1002. [PMID: 28562301 DOI: 10.1542/peds.2017-1002] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pain is a frequent and significant problem for children with impairment of the central nervous system, with the highest frequency and severity occurring in children with the greatest impairment. Despite the significance of the problem, this population remains vulnerable to underrecognition and undertreatment of pain. Barriers to treatment may include uncertainty in identifying pain along with limited experience and fear with the use of medications for pain treatment. Behavioral pain-assessment tools are reviewed in this clinical report, along with other strategies for monitoring pain after an intervention. Sources of pain in this population include acute-onset pain attributable to tissue injury or inflammation resulting in nociceptive pain, with pain then expected to resolve after treatment directed at the source. Other sources can result in chronic intermittent pain that, for many, occurs on a weekly to daily basis, commonly attributed to gastroesophageal reflux, spasticity, and hip subluxation. Most challenging are pain sources attributable to the impaired central nervous system, requiring empirical medication trials directed at causes that cannot be identified by diagnostic tests, such as central neuropathic pain. Interventions reviewed include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, α-agonists, and opioids. This clinical report aims to address, with evidence-based guidance, the inherent challenges with the goal to improve comfort throughout life in this vulnerable group of children.
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Affiliation(s)
- Julie Hauer
- Complex Care Service, Division of General Pediatrics, Boston Children’s Hospital, Assistant Professor, Harvard Medical School, Boston Massachusetts
- Seven Hills Pediatric Center, Groton, Massachusetts; and
| | - Amy J. Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pediatric Rehabilitation Medicine, Rehabilitation Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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16
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Stanek JL, Emerson JA, Murdock FA, Petroski GF. Growth characteristics in cerebral palsy subtypes: a comparative assessment. Dev Med Child Neurol 2016; 58:931-5. [PMID: 27059686 DOI: 10.1111/dmcn.13116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
Abstract
AIM Children with quadriplegic cerebral palsy (CP) have been found to have growth rates that differ from those of children with typical development. Little research has been performed to distinguish whether growth patterns in hemiplegic, diplegic, and quadriplegic CP differ from one another. The purpose of this study was to compare growth of children with quadriplegic, hemiplegic, and diplegic CP. METHOD Retrospective data were collected from the electronic medical record of patients with CP at an outpatient center. Linear mixed models were used to examine growth by diagnosis, using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes 343.0 (diplegia), 343.1 (hemiplegia), and 343.2 (quadriplegia). RESULTS Heights and weights of children with quadriplegic CP were consistently lower than those with hemiplegic or diplegic CP. Children with hemiplegic CP had greater heights and weights than other CP subtypes. There were statistically significant differences in weight gain curves among the three diagnoses for males (p<0.05). INTERPRETATION Our study reveals differences in growth rates between hemiplegic, diplegic, and quadriplegic CP subtypes.
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Affiliation(s)
- Jeremy L Stanek
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA
| | - Jane A Emerson
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA
| | - Fred A Murdock
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA
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17
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Kapadia MZ, Joachim KC, Balasingham C, Cohen E, Mahant S, Nelson K, Maguire JL, Guttmann A, Offringa M. A Core Outcome Set for Children With Feeding Tubes and Neurologic Impairment: A Systematic Review. Pediatrics 2016; 138:peds.2015-3967. [PMID: 27365302 DOI: 10.1542/peds.2015-3967] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Uncertainty exists about the impacts of feeding tubes on neurologically impaired children. Core outcome sets (COS) standardize outcome selection, definition, measurement, and reporting. OBJECTIVE To synthesize an evidence base of qualitative data on all outcomes selected and/or reported for neurologically impaired children 0 to 18 years living with gastrostomy/gastrojejunostomy tubes. DATA SOURCES Medline, Embase, and Cochrane Register databases searched from inception to March 2014. STUDY SELECTION Articles examining health outcomes of neurologically impaired children living with feeding tubes. DATA EXTRACTION Outcomes were extracted and assigned to modified Outcome Measures in Rheumatology 2.0 Filter core areas; death, life impact, resource use, pathophysiological manifestations, growth and development. RESULTS We identified 120 unique outcomes with substantial heterogeneity in definition, measurement, and frequency of selection and/or reporting: "pathophysiological manifestation" outcomes (n = 83) in 79% of articles; "growth and development" outcomes (n = 13) in 55% of articles; "death" outcomes (n = 3) and "life impact" outcomes (n = 17) in 39% and 37% of articles, respectively; "resource use" outcomes (n = 4) in 14%. Weight (50%), gastroesophageal reflux (35%), and site infection (25%) were the most frequently reported outcomes. LIMITATIONS We were unable to investigate effect size of outcomes because quantitative data were not collected. CONCLUSIONS The paucity of outcomes assessed for life impact, resource use and death hinders meaningful evidence synthesis. A COS could help overcome the current wide heterogeneity in selection and definition. These results will form the basis of a consensus process to produce a final COS.
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Affiliation(s)
- Mufiza Z Kapadia
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences,
| | - Kariym C Joachim
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Chrinna Balasingham
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Eyal Cohen
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Sanjay Mahant
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Katherine Nelson
- Division of Paediatric Medicine, Institute of Health Policy, Management and Evaluation, and Paediatric Advanced Care Team, Department of Paediatrics, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, and Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Martin Offringa
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
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18
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Kalra S, Aggarwal A, Chillar N, Faridi MMA. Comparison of micronutrient levels in children with cerebral palsy and neurologically normal controls. Indian J Pediatr 2015; 82:140-4. [PMID: 25106843 DOI: 10.1007/s12098-014-1543-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/14/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To measure levels of micronutrients in children with cerebral palsy and compare them with neurologically normal children of similar nutritional status. METHODS Fifty children with cerebral palsy (2-12 y) and 50 age and sex matched controls of similar nutritional status were enrolled. Detailed dietary history was recorded and nutritional status assessed. Venous blood (3 ml) was drawn for analysis. Micronutrient levels were measured as per standard technique. RESULTS Serum iron was 12.6 ± 5.9 and 20.9 ± 3.3 μmol/L in CP and controls respectively (P < 0.001). Mean copper levels were 106.2 ± 38.3 μg/dl in CP and 128.8 ± 20.2 μg/dl in controls (P < 0.001); magnesium levels were 1.97 ± 0.4 and 2.2 ± 0.3 mg/dl (P = 0.003). Zinc levels were similar in CP and controls (P = 0.979). The mean energy intake was significantly less in CP (P = 0.016). Mean protein intake did not vary significantly (P = 0.847). No correlation was found between energy intake and serum levels of micronutrients (P > 0.05). There was no difference in micronutrient levels with respect to gross motor functional classification system (GMFCS) grades and limb involvement (P > 0.05). CONCLUSIONS The serum levels of iron, copper and magnesium are significantly less in children with cerebral palsy, hence the need for supplementation.
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Affiliation(s)
- Swati Kalra
- Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, New Delhi, India
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19
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Rempel G. The Importance of Good Nutrition in Children with Cerebral Palsy. Phys Med Rehabil Clin N Am 2015; 26:39-56. [DOI: 10.1016/j.pmr.2014.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Bell KL, Samson-Fang L. Nutritional management of children with cerebral palsy. Eur J Clin Nutr 2014; 67 Suppl 2:S13-6. [PMID: 24301003 DOI: 10.1038/ejcn.2013.225] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Children with severe cerebral palsy and particularly those with oropharyngeal dysfunction are at risk of poor nutritional status. Determining the need and the mode of nutritional intervention is multifactorial and requires multiple methodologies. First-line treatment typically involves oral nutritional support for those children who are safe to consume an oral diet. Enteral tube feeding may need to be considered in children with undernutrition where poor weight gain continues despite oral nutritional support, or in those with oropharyngeal dysphagia and an unsafe swallow. Estimates for energy and protein requirements provide a starting point only, and ongoing assessment and monitoring is essential to ensure nutritional needs are being met, that complications are adequately managed and to avoid over or under feeding.
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Affiliation(s)
- K L Bell
- 1] Queensland Cerebral Palsy and Rehabilitation Research Centre, Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia [2] Department of Paediatric Rehabilitation, Children's Health Queensland Hospital and Health Service, Herston, Brisbane, Queensland, Australia
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21
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Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr 2014; 67 Suppl 2:S9-12. [PMID: 24301008 DOI: 10.1038/ejcn.2013.224] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.
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Affiliation(s)
- J C Arvedson
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
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22
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Walker JL, Bell KL, Stevenson RD, Weir KA, Boyd RN, Davies PSW. Differences in body composition according to functional ability in preschool-aged children with cerebral palsy. Clin Nutr 2014; 34:140-5. [PMID: 24613145 DOI: 10.1016/j.clnu.2014.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 02/03/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND & AIMS Altered body composition is evident in school children with cerebral palsy (CP). Fat free mass and fat mass amounts differ according to functional ability and compared to typically developing children (TDC). The extent to which body composition is altered in preschool-aged children with CP is unknown. We aimed to determine the fat free mass index (FFMI) and body fat percentage (BF%) of preschool-aged children with CP and investigate differences according to functional ability and compared to TDC. METHODS Eighty-five children with CP (68% male) of all functional abilities, motor types and distributions and 16 TDC (63% male) aged 1.4-5.1 years participated in this cross-sectional study. Body composition was determined via isotope dilution. Children with CP were classified into groups based on their Gross Motor Function Classification System (GMFCS) level. Statistical analyses were via ANOVA, ANCOVA, post-hoc Tukey HSD tests, independent t-tests and multiple regressions. RESULTS There were no significant differences in FFMI or BF% when comparing all children with CP to TDC. Children classified as GMFCS levels III, IV and V had significantly lower FFMI levels compared to children classified as GMFCS I and II (p < 0.05). Children of GMFCS IV and V had the highest mean (± SD) BF% of all children (24.6% (± 10.7%)), significantly higher than children of GMFCS I and II (18.6% (± 6.8%), p < 0.05). CONCLUSIONS Altered body composition is evident in preschool-aged children with CP, with a trend towards lower FFMI levels and greater BF% across functional ability levels from GMFCS I to V. Further research is required to determine optimal body composition parameters and investigate contributing factors. CLINICAL TRIAL REGISTRY Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12611000616976.
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Affiliation(s)
- Jacqueline L Walker
- Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Old Milk Kitchen, Building 916, Cnr Fourth and Back Rds (Southern Annexe of Edith Cavell Building), Herston, QLD 4029, Australia; Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Level 7, Block 6, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia.
| | - Kristie L Bell
- Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Old Milk Kitchen, Building 916, Cnr Fourth and Back Rds (Southern Annexe of Edith Cavell Building), Herston, QLD 4029, Australia; Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Level 7, Block 6, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia; Department of Paediatric Rehabilitation, Royal Children's Hospital, Brisbane, QLD, Australia.
| | - Richard D Stevenson
- Department of Pediatrics, Division of Developmental Pediatrics, Kluge Children's Rehabilitation Center and Research Institute, University of Virginia, 2270 Ivy Road, Charlottesville, VA 22903, USA.
| | - Kelly A Weir
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Level 7, Block 6, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Speech Pathology Department, Level 4, Coles Health Services Building, Royal Children's Hospital, Herston, QLD 4029, Australia; Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Level 7, Block 6, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia.
| | - Peter S W Davies
- Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Old Milk Kitchen, Building 916, Cnr Fourth and Back Rds (Southern Annexe of Edith Cavell Building), Herston, QLD 4029, Australia.
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Ferluga ED, Sathe NA, Krishnaswami S, Mcpheeters ML. Surgical intervention for feeding and nutrition difficulties in cerebral palsy: a systematic review. Dev Med Child Neurol 2014; 56:31-43. [PMID: 23738903 DOI: 10.1111/dmcn.12170] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2013] [Indexed: 12/27/2022]
Abstract
AIM The aim of the study was to systematically review surgical intervention for feeding difficulties in cerebral palsy. METHOD We searched databases including MEDLINE from 1980 to July 2012. Two reviewers independently assessed studies and rated the overall quality and strength of the evidence. RESULTS Thirteen publications (11 unique studies) met the inclusion criteria and addressed gastrostomy outcomes or treatment of reflux via fundoplication. In nine studies, gastrostomy-fed children gained weight. Relative to typically developing populations, baseline weight z-scores ranged from -3.56 to -0.39 and follow-up z-scores ranged from -2.63 to -0.33. Other growth measures were mixed. Two studies assessed fundoplication: in one, both Nissen fundoplication and vertical gastric plication reduced reflux (by 57% and 43% respectively), while in one case series, reflux recurred within 12 months in 30% of children. The highest rates of adverse events across studies were site infection (59%), granulation tissue (42%), and recurrent reflux (30%). Death rates ranged from 7 to 29%; however, the underlying cause was probably not surgery. INTERPRETATION Evidence for the effectiveness of surgical interventions is insufficient to low. Studies of gastrostomy typically demonstrated significant weight gain. Results for other measures were mixed. Many children remained underweight, although, given a lack of appropriate reference standards, these results should be interpreted cautiously.
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Kuperminc MN, Gottrand F, Samson-Fang L, Arvedson J, Bell K, Craig GM, Sullivan PB. Nutritional management of children with cerebral palsy: a practical guide. Eur J Clin Nutr 2013; 67 Suppl 2:S21-3. [DOI: 10.1038/ejcn.2013.227] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013; 55:885-910. [PMID: 23962350 DOI: 10.1111/dmcn.12246] [Citation(s) in RCA: 782] [Impact Index Per Article: 71.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2013] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP). METHOD This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health. RESULTS Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded 'do it' (green go); 58% (76 out of 131) 'probably do it' (yellow measure); 20% (26 out of 131) 'probably do not do it' (yellow measure); and 6% (8 out of 131) 'do not do it' (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). INTERPRETATION Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
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26
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Åvitsland TL, Birketvedt K, Bjørnland K, Emblem R. Parent-Reported Effects of Gastrostomy Tube Placement. Nutr Clin Pract 2013; 28:493-8. [DOI: 10.1177/0884533613486484] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tone Lise Åvitsland
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Birketvedt
- National Resource Center for Feeding and Nutritional Difficulties in Children, Section for Child Neurology, Oslo University Hospital, Oslo, Norway
| | - Kristin Bjørnland
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Emblem
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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27
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Gottrand M, Muyshont L, Couttenier F, Beghin L, Martigne L, Coopman S, Turck D, Michaud L, Guimber D, Gottrand F. Micronutrient Status of Children Receiving Prolonged Enteral Nutrition. ANNALS OF NUTRITION AND METABOLISM 2013; 63:152-8. [DOI: 10.1159/000353704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 06/11/2013] [Indexed: 11/19/2022]
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28
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Walker JL, Bell KL, Stevenson RD, Weir KA, Boyd RN, Davies PS. Relationships between Dietary Intake and Body Composition according to Gross Motor Functional Ability in Preschool-Aged Children with Cerebral Palsy. ANNALS OF NUTRITION AND METABOLISM 2012. [DOI: 10.1159/000342557] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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29
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McGowan JE, Fenton TR, Wade AW, Branton JL, Robertson M. An exploratory study of sodium, potassium, and fluid nutrition status of tube-fed nonambulatory children with severe cerebral palsy. Appl Physiol Nutr Metab 2012; 37:715-23. [PMID: 22667347 DOI: 10.1139/h2012-050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Children with severe cerebral palsy (CP) often have lower mineral intakes than healthy children. It is unknown if their lower nutrient intakes are adequate to meet their needs. The objective of this study was to examine the sodium, potassium, phosphate, and fluid status of primarily tube-fed nonambulatory children with severe CP. The design consisted of a cross-sectional exploratory study and a clinical trial of sodium supplementation. Nutritional status was determined among primarily tube-fed children (aged 2 to 17 years) with CP based on blood and urine samples, anthropometry, and 3-day food records. Mineral and fluid status was evaluated by a nephrologist blind to nutrient intakes. Twenty children supplied food records, blood samples, and anthropometric measurements, and 16 supplied urine samples. Six (37.5%) of those who provided urine samples were considered possibly dehydrated, as urine osmolality was >600 mmol·kg(-1). Six (60%) of the 10 children with satisfactory fluid status (low urine osmolality) were considered to have a possible dietary sodium deficiency based on a very low urine sodium concentration (<20 mmol·L(-1)). Those considered to have a possible dietary sodium deficiency had a significantly lower sodium intake (48% ± 15% Adequate Intake (AI)) compared with those considered sodium sufficient (73% ± 20% AI) (p = 0.031). One child was considered possibly phosphorus deficient, but none was assessed as likely potassium deficient. The conclusion was that sodium deficiencies were likely prevalent among the children. The findings from this small observational study suggest that sodium intakes for tube-fed children with CP should be maintained near the AI for their age. Hydration status of children receiving hypercaloric formulas should be monitored.
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Affiliation(s)
- Joan Elizabeth McGowan
- Department of Nutrition Services, Alberta Children's Hospital, Alberta Health Services, Calgary, AB T3B 6A8, Canada.
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Dahlseng MO, Finbråten AK, Júlíusson PB, Skranes J, Andersen G, Vik T. Feeding problems, growth and nutritional status in children with cerebral palsy. Acta Paediatr 2012; 101:92-8. [PMID: 21767308 DOI: 10.1111/j.1651-2227.2011.02412.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim was to estimate the prevalence of feeding and nutritional problems in children with cerebral palsy (CP) in Norway. METHODS Data were abstracted from the Norwegian CP Register for 661 (368 boys) children born 1996-2003 (mean age 6 years 7 months; SD: 1.5). For children born from 1999 to 2003, weight and height were available. Body mass index (BMI) (kg/m(2)) was used to assess nutritional status. RESULTS One hundred and thirty-two (21%) children with CP were completely dependent on assistance during feeding. The prevalence of gastrostomy tube feeding was 14%. Longer duration of gastrostomy tube feeding was associated with higher weight and BMI, but not with height. Only 63% of the children with CP had normal BMI, 7% had grade 3 thinness, while the prevalence of overweight and obesity in our study was 16%. In all, 20% of the children had mean z-scores for weight and/or height below - 2 SD. CONCLUSION Feeding problems in children with CP were common and associated with poor linear growth. A high proportion of the children were undernourished. Moreover, our results suggest that gastrostomy tube feeding may have been introduced too late in some children.
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Affiliation(s)
- Magnus Odin Dahlseng
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Magnuson B, Peppard A, Auer Flomenhoft D. Hypocaloric considerations in patients with potentially hypometabolic disease States. Nutr Clin Pract 2011; 26:253-60. [PMID: 21586410 DOI: 10.1177/0884533611405673] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The provision of nutrition has traditionally been driven by the desire to provide adequate calories. However, over the past decade it has become evident that provision of excess calories can be detrimental to patients' outcomes in both critical care and long-term care settings. This review examines patient populations for whom hypocaloric nutrition can be both appropriate and beneficial. In specific situations, critically ill patients, such as those with obesity, stroke, and spinal cord injury, may have decreased energy requirements. In patients with spinal cord injury, the level of injury significantly correlates with the extent of reduced caloric energy expenditure. Ventilator-dependent patients with amyotrophic lateral sclerosis (ALS) have decreased energy needs; energy expenditure for ALS patients is lower than the predictive equation value. Aging patients will have decreased energy needs relative to a reduction in lean body mass. Patients with cerebral palsy (CP) have significantly lower caloric requirements than anticipated using predictive equations. Patients with CP pose a particular challenge in nutrition assessment. Several studies demonstrate that patients with CP have significantly lower caloric requirements than anticipated using predictive equations; thus, patients with CP benefit from indirect calorimetry. Provision of nutrition for obese patients is briefly addressed, as this is an increasingly important consideration for nutrition support in both the critical care and long-term care settings. When indirect calorimetry is not available, clinicians should remember that most patients will have low resting energy expenditure regardless of functional status and require frequent evaluation during institution of nutrition recommendations to guard against overfeeding and obesity.
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Somerville H, O'Loughlin E. Gastrostomy feeding in cerebral palsy: enough and no more. Dev Med Child Neurol 2010; 52:1076. [PMID: 21175462 DOI: 10.1111/j.1469-8749.2010.03805.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Helen Somerville
- Department of Gastroenterology, The Children's Hospital Westmead, Sydney, Australia
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