Koen Huysentruyt1, Fien Geeraert2, Heidelinde Allemon3, Peter Prinzie4, Mathieu Roelants3, Els Ortibus5, Yvan Vandenplas6, Jean De Schepper7. 1. Pediatric Gastroenterology, KidZ Health Castle, Vrije Universiteit Brussel (VUB), Brussels, Belgium. Electronic address: koen.huysentruyt@uzbrussel.be. 2. DC GID(t)S, Dominiek Savio Institute, Belgium. 3. Environment and Health, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Belgium. 4. DC GID(t)S, Dominiek Savio Institute, Belgium; Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, the Netherlands. 5. Department of Development and Regeneration, KU Leuven, Belgium. 6. Pediatric Gastroenterology, KidZ Health Castle, Vrije Universiteit Brussel (VUB), Brussels, Belgium. 7. Pediatric Endocrinology, KidZ Health Castle, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Abstract
BACKGROUND & AIMS: Children with cerebral palsy (CP) are at risk for under-nutrition. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines identified anthropometric nutritional red flags for neurologically impaired children: weight for age z-score (WFA) < -2, triceps skinfold (TSF) or arm muscle area (AMA) < 10th centile and faltering weight. This study aimed to (1) evaluate the nutritional status of Flemish children and adolescents with CP using different anthropometric indicators; (2) assess the prevalence of nutritional red flags and (3) identify risk factors for low anthropometric parameters. METHODS: This study was a prospective, longitudinal observational study recruiting children and adolescents with CP (2-20 years) in 9 specialized Flemish centres. Measurements were performed at baseline (t1, n = 325), after 6 (t2, total n = 268) and 12 months (t3, total n = 191). WFA z-scores were based on Flemish growth charts; TSF, subscapular skinfolds (SSF) and AMA compared with US reference data. Weight faltering was defined as ≥0.5 decrease in weight SDS at t2 or t3. RESULTS: At t1 50 patients (15.4%) were classified as gross motor function classification system (GMFCS) 1, 95 (29.2%) as GMFCS 2, 49 (15.1%) as GMFCS 3, 54 (16.6%) as GMFCS 4, and 77 (23.7%) as GMFCS 5. The overall median (Q1; Q3) age was 11.7 (8.2; 15.9) years; 61.5% were boys and 22 (6.8%) had a gastrostomy (17 (22.1%) of GMFCS 5 group). The median (Q1; Q3) WFA z-score was -1.13 (-2.6; -0.1); 71.4% of the GMFCS 5 children had a WFA z-score < -2. The median (Q1; Q3) MUAC z-score was 0.17 (-0.7; 1.0); 16.9% of the GFMCS 5 children had MUAC z-score < -2. Median (Q1; Q3) TSF and SSF z-scores were respectively -0.01 (-0.8; 0.9) and 0.27 (-0.3; 0.9). All anthropometric indices tended to decrease with increasing GMFCS (p < 0.001). At t1 42.1% had at least one nutritional red flag, at t2 40.3% and at t3 41.4%. Of those with at least one nutritional red flag at t1 or t2, respectively 14.7% and 18.8% suffered weight loss 6 months later. A GMFCS >2 and dysphagia were associated with a higher risk for lower scores of nearly all nutritional indices. CONCLUSIONS: Underweight was detected in almost three quarters of CP patients with GMFCS 5 classification, whereas deficits in subcutaneous fat and arm muscle reserve were observed in one fifth. Nutritional red flags, present in about 40% of the Flemish CP children, were apparently not successfully addressed in clinical practice, since up to one-fifth of CP patients with warning signs lost even further weight in the following 6 months. Beside a GMFCS >2, dysphagia was one of the most common conditions influencing the presence of low nutritional indices.
BACKGROUND & AIMS:Children with cerebral palsy (CP) are at risk for under-nutrition. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines identified anthropometric nutritional red flags for neurologically impaired children: weight for age z-score (WFA) < -2, triceps skinfold (TSF) or arm muscle area (AMA) < 10th centile and faltering weight. This study aimed to (1) evaluate the nutritional status of Flemish children and adolescents with CP using different anthropometric indicators; (2) assess the prevalence of nutritional red flags and (3) identify risk factors for low anthropometric parameters. METHODS: This study was a prospective, longitudinal observational study recruiting children and adolescents with CP (2-20 years) in 9 specialized Flemish centres. Measurements were performed at baseline (t1, n = 325), after 6 (t2, total n = 268) and 12 months (t3, total n = 191). WFA z-scores were based on Flemish growth charts; TSF, subscapular skinfolds (SSF) and AMA compared with US reference data. Weight faltering was defined as ≥0.5 decrease in weight SDS at t2 or t3. RESULTS: At t1 50 patients (15.4%) were classified as gross motor function classification system (GMFCS) 1, 95 (29.2%) as GMFCS 2, 49 (15.1%) as GMFCS 3, 54 (16.6%) as GMFCS 4, and 77 (23.7%) as GMFCS 5. The overall median (Q1; Q3) age was 11.7 (8.2; 15.9) years; 61.5% were boys and 22 (6.8%) had a gastrostomy (17 (22.1%) of GMFCS 5 group). The median (Q1; Q3) WFA z-score was -1.13 (-2.6; -0.1); 71.4% of the GMFCS 5 children had a WFA z-score < -2. The median (Q1; Q3) MUAC z-score was 0.17 (-0.7; 1.0); 16.9% of the GFMCS 5 children had MUAC z-score < -2. Median (Q1; Q3) TSF and SSF z-scores were respectively -0.01 (-0.8; 0.9) and 0.27 (-0.3; 0.9). All anthropometric indices tended to decrease with increasing GMFCS (p < 0.001). At t1 42.1% had at least one nutritional red flag, at t2 40.3% and at t3 41.4%. Of those with at least one nutritional red flag at t1 or t2, respectively 14.7% and 18.8% suffered weight loss 6 months later. A GMFCS >2 and dysphagia were associated with a higher risk for lower scores of nearly all nutritional indices. CONCLUSIONS: Underweight was detected in almost three quarters of CP patients with GMFCS 5 classification, whereas deficits in subcutaneous fat and arm muscle reserve were observed in one fifth. Nutritional red flags, present in about 40% of the Flemish CP children, were apparently not successfully addressed in clinical practice, since up to one-fifth of CP patients with warning signs lost even further weight in the following 6 months. Beside a GMFCS >2, dysphagia was one of the most common conditions influencing the presence of low nutritional indices.
Authors: Byron Alexander Foster; Jennifer E Lane; Elizabeth Massey; Michelle Noelck; Sarah Green; Jared P Austin Journal: Hosp Pediatr Date: 2020-11-05