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Validation of US cerebral palsy growth charts using a UK cohort
Charlotte M Wright1, Lucy Reynolds2, Emily Ingram1
1Department of Child Health, MVLS College, University of Glasgow, Glasgow, UK.
Insights
British children with cerebral palsy (CP) fit well on US-based CP growth charts, especially for weight and BMI. This suggests the US charts are useful for monitoring growth in UK children with CP, regardless of severity.
Area of Science:
- Pediatrics
- Clinical Medicine
- Growth Monitoring
Background:
- Growth charts are essential for monitoring child development.
- Cerebral palsy (CP) affects motor function and can impact growth.
- Existing growth charts for CP are primarily based on US data.
Purpose of the Study:
- To evaluate the suitability of US-based cerebral palsy (CP) growth charts for British children.
- To compare the fit of British CP data to US CP charts versus standard UK-WHO charts.
- To assess growth patterns across different severity levels of CP using the Gross Motor Function Classification System (GMFCS).
Main Methods:
- Utilized the lambda-mu-sigma (LMS) method for reanalyzing US CP growth data.
- Calculated standard deviation z-scores for height, weight, and body mass index (BMI).
- Compared growth data of 195 Glasgow, UK children with CP against US CP charts and UK-WHO charts.
Main Results:
- British children with CP showed significant divergence from UK-WHO charts, particularly at higher GMFCS levels.
- Mean height for GMFCS level V was near the second UK-WHO centile.
- Compared to US CP charts, British children's mean height and weight z-scores were between the 50th and 75th centiles; BMI was just below the 50th centile across all GMFCS levels.
Conclusions:
- British children with severe CP appear smaller on non-CP charts but fit well on US CP charts for weight and BMI.
- US CP growth charts provide a reasonable reference for height and a good fit for weight and BMI in British children with CP.
- LMS method and US CP charts facilitate local z-score calculation and chart production for UK children with CP.
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.
