Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes

The nutritional status according to anthropometric indexes and growth patterns in children and adolescents with cerebral palsy: A scoping review of the literature

BACKGROUND

Determining the nutritional status of children with cerebral palsy (CP) presents numerous challenges. Accurate nutritional assessment is crucial in this population to ensure the provision of appropriate and effective nutritional interventions.

AIM

This scoping review aimed to analyze the most frequently used anthropometric indexes and growth patterns to determine the nutritional status of children and adolescents with CP.

METHODS

The literature search was performed in six databases Scopus, Cochrane Library, Web of Science, SciELO, Medline and PubMed. It was conducted on studies that included children aged 0 to 18 years. Sixty-three publications met the inclusion criteria.

RESULTS

The prevalence of undernutrition was higher when WHO growth standards and CDC growth charts were used (93.3% and 56.8%, respectively), whereas the prevalence of normal nutritional status was higher when US CP growth charts were used (92.5%). The prevalence of stunting was higher with the WHO growth standards (97.7%) and lowest with the US CP growth charts (4.3%). The WHO growth standards were the most frequently used (50.8%), followed by the CDC growth charts (22.2%) and the US CP growth charts (12.7%).

CONCLUSION

The index with more relevance in this scoping review was BMI since it was addressed in 77.8% of the studies. When assessing the nutritional status with typically developed children's patterns, there was a higher prevalence of undernutrition and stunting. When using US CP growth charts, more children were included in the normal range. More studies are needed to determine which growth pattern is a better indicator of health.

Caregivers' experiences of feeding children with cerebral palsy: a systematic review of qualitative evidence

OBJECTIVE

The objective of this review was to investigate the feeding experiences of caregivers of children with cerebral palsy, in any setting, by identifying, critically appraising, and synthesizing the relevant literature.

INTRODUCTION

Feeding difficulties in children with cerebral palsy are common and affect both children and caregivers. Difficulties include dysphagia and risk of aspiration, which can result in poor growth and development. Caregivers find feeding challenging and stressful due to the time involved, fear of aspiration, and the pressure of meeting other family demands. Finding ways to support caregivers effectively in feeding will have important health and quality-of-life outcomes for caregivers and their children with cerebral palsy.

INCLUSION CRITERIA

Studies with qualitative data exploring informal caregivers' experiences (eg, perspectives, challenges, feelings) of feeding children with cerebral palsy, in any country or setting, were included. Informal caregivers (eg, parents, foster carers, grandparents) could be of any age, gender, or cultural background. Children with cerebral palsy of any severity level were included. Formal caregivers, such as health professionals, were ineligible. The feeding method could include oral feeding, tube feeding, or both.

METHODS

The JBI methodology for systematic reviews of qualitative evidence was followed. The databases searched on June 27, 2023, included CINAHL (EBSCOhost), APA PsycINFO (Ovid), MEDLINE (Ovid), ProQuest Central, Scopus, and ProQuest Dissertations and Theses. Two members of the review team independently screened titles and abstracts, and full texts of eligible studies. Three members of the review team independently appraised selected studies for methodological quality. The meta-aggregation approach was used for data synthesis to pool findings from included studies to form categories and synthesized findings. Finally, the ConQual approach was used to establish confidence in the synthesized findings based on their dependability and credibility.

RESULTS

From the literature search and citation searching, 619 records were screened, from which 10 studies were included in the review. A total of 196 findings were extracted for analysis, which resulted in 19 categories and 5 synthesized findings. The synthesized findings were "Feeding and feeding difficulties," "Caregiver emotions and burden around feeding a child with cerebral palsy," "Caregiver support and feeding," "Feeding, social interaction, and mothering," and "Gastrostomy tube decisions and perceptions." The overall ConQual score for each synthesized finding was rated as low.

CONCLUSIONS

Feeding a child with CP was a difficult experience for caregivers. Caregivers were able to problem-solve feeding issues, but they often felt unsupported by health professionals and services. Feeding negatively impacted caregivers' and children's social interactions outside the home, where caregivers sought to achieve normalcy for their child and family. However, feeding was described as an essential part of mothering, and caregivers felt like a failure if they could not feed their child orally. Caregivers struggled with the decision to allow their child to have a gastrostomy tube, but most viewed it positively once it was inserted. More research into other cultures and research into fathers' experiences of feeding children with cerebral palsy is recommended.

Outpatient Management of Clinical Comorbidities in Children With Cerebral Palsy in Low- and Middle-Income Countries

BACKGROUND

Cerebral palsy (CP) is the most common physical disability of childhood. Its prevalence in low-and middle-income countries (LMICs) is over 3/1000 live births, about double the 1.6/1000 in high income countries (HICs). Multimorbidity is highly prevalent in CP. In LMICs, there are higher rates of prevalence, severity, comorbidities and mortality in children with CP. The evidence base for the recommendations in CP emanates overwhelmingly from studies conducted in HICs. Research conducted in LMICs settings, involving local clinicians, considering local context and investigating local solutions are urgently needed.

METHODS

This scoping review aimed to identify and synthesise current evidence on management of clinical comorbidities in children with CP in LMICs. The Joanna Briggs Institute guidelines were followed for the data extraction and analysis phases. The following questions guided the scoping review: What are the main clinical comorbidities in children with CP? What are the gold standards for diagnosis and treatment of these comorbidities? What options do we have to diagnose and treat these comorbidities in LMICs when gold standards are not available?

RESULTS

A total of 22 188 citations were identified by our search strategy, with 21 380 remaining after the removal of 808 duplicates. After screening titles and abstracts, 1918 citations progressed to full text review. A total of 194 articles met the eligibility criteria and were included in the review. The guiding questions of the review were answered for the following morbidities: respiratory impairments, dysphagia and aspiration, gastroesophageal reflux disease, drooling, obstructive sleep apnea syndrome, malnutrition, constipation, epilepsy, sleep disorders, spasticity, dystonia, pain, hip disorders, scoliosis and osteoporosis.

CONCLUSION

This article highlights the need for interventions adapted to the realities of LMICs. Empowering paediatricians and healthcare professionals in LMICs is crucial for early diagnosis and proactive interventions. Specific guidelines for LMICs can better guide professionals in managing these complex conditions.

Nutritional risk screening and nutritional assessment for children with cerebral palsy: A review of the current research status and future directions

BACKGROUND

Although the primary impairment involved in Cerebral palsy (CP) is motor function, malnutrition is also common. However, there is a lack of tool recommendations for early malnutrition risk screening in children with CP, and the means of nutritional intervention for children with CP are also limited.

METHODS

This study systematically searched the literature about clinical nutrition related content of cerebral palsy in Pubmed, MEDLINE, Embase, and the Cochrane Library in Jan 2024 and by hand searching, and we checked reference lists and citations to identify additional studies. Search terms include cerebral palsy, children, diagnosis, prediction, malnutrition, nutritional risk screening, nutritional assessment, nutritional support. Additions are marked in red in the modified version.

RESULTS

The timing of diagnosis of CP has been moving forward, and some new diagnostic tools have been developed. Nutritional status is correlated with regional economic level, but there is still a malnutrition rate of nearly 30 % in developed countries. Severe restrictions in terms of gross motor function, swallowing dysfunction, feeding difficulties, cognitive impairment, and insufficient energy intake are common risk factors for malnutrition in children with CP. Z-score should be calculated in combination with measurement indicators in the assessment of physical development of children with CP. The nutritional outcomes of children with CP can be improved by various means, including diversified a Nutrition Support Team (NST) interventions.

CONCLUSIONS

The incidence of malnutrition in children with CP is high, which needs to be paid more attention. More effective malnutrition risk screening tools need to be developed for children with CP to guide the implementation of comprehensive and personalized nutritional interventions and improve malnutrient-related outcomes.

The Prevalence and Risk Analysis of Cerebral Palsy and Other Neuro-Psychological Comorbidities in Children with Low Birth Weight in Taiwan: A Nationwide Population-Based Cohort Study

Background: This study evaluated early childhood comorbidities of cerebral palsy (CP) in low birth weight (LBW) children and assessed the impact of maternal bio-psychosocial factors on CP risk in preterm infants of varying birth weights (BWs). Methods: Data from 15,181 preterm infants (2009-2013) and 151,810 controls were analyzed using Taiwan's National Health Insurance Research Database. CP prevalence and LBW-associated comorbidities were examined, and odds ratios (ORs) were calculated. Results: This study confirmed increasing prematurity and LBW rates in Taiwan, with LBW infants showing higher CP prevalence. Significant maternal risk factors included age extremes (<20 and >40 years). LBW infants exhibited higher risks for respiratory, circulatory, nervous system, and psycho-developmental comorbidities compared with controls, with the lowest BW having even higher ORs. Maternal factors such as family income, the number of hospital admissions, and length of hospital stay were remarkably correlated with BW and subsequent complications. Each additional gestational week crucially reduced the risk of complications in premature infants. Conclusions: LBW infants are at a higher risk for CP and various comorbidities, with maternal bio-psychosocial factors playing a critical role. Addressing these factors in prenatal care and interventions is essential to improve outcomes for premature infants.

Towards functional improvement of motor disorders associated with cerebral palsy

Cerebral palsy is a lifelong neurodevelopmental condition arising from non-progressive disorders occurring in the fetal or infant brain. Cerebral palsy has long been categorised into discrete motor types based on the predominance of spasticity, dyskinesia, or ataxia. However, these motor disorders, muscle weakness, hypotonia, and impaired selective movements should also be discriminated across the range of presentations and along the lifespan. Although cerebral palsy is permanent, function changes across the lifespan, indicating the importance of interventions to improve outcomes in motor disorders associated with the condition. Mounting evidence exists for the inclusion of several interventions, including active surveillance, adapted physical activity, and nutrition, to prevent secondary and tertiary complications. Avenues for future research include the development of evidence-based recommendations, low-cost and high-quality alternatives to existing therapies to ensure universal access, standardised cerebral palsy registers to harmonise epidemiological and clinical information, improved adult screening and check-up programmes to facilitate positive lived experiences, and phase 3 trials for new interventions.

Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review

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.