Nutritional red flags in children with cerebral palsy. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Huysentruyt, Koen; Geeraert, Fien; Allemon, Heidelinde; Prinzie, Peter; Roelants, Mathieu; Ortibus, Els; Vandenplas, Yvan; De Schepper, Jean
• Is Part Of: Clinical nutrition. Volume 39:Issue 2(2020)
• Page Start: 548
• Page End: 553
• Publication Date: 2020-02
• Subjects: Cerebral palsy -- Nutritional status -- Nutritional assessment -- Nutritional risk; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2019.02.040
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: 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 ( t 1, n = 325), after 6 ( t 2, total n = 268) and 12 months ( t 3, 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 t 2 or t 3 . Results: At t 1 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 t 1 42.1% had at least one nutritional red flag, at t 2 40.3% and at t 3 41.4%. Of those with at least one nutritional red flag at t 1 or t 2, 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.