Growth in infants, children and adolescents with unilateral and bilateral cerebral palsy
Maria de Las Mercedes Ruiz Brunner1,2, Eduardo Cuestas3,4, Florian Heinen5
1Instituto de Investigación en Ciencias de la Salud, Universidad Nacional de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas, Bv de la Reforma S/N, Pabellón de Biología Celular, Ciudad Universitaria, CP: 5016, Córdoba, Argentina. mercedesruizb@fcm.unc.edu.ar.
Insights
Children with bilateral cerebral palsy (CP) show significantly reduced growth compared to unilateral CP. This impaired growth is linked to severe motor deficits and swallowing difficulties in bilateral CP.
Area of Science:
- Pediatrics
- Neurology
- Growth and Development
Background:
- Cerebral palsy (CP) affects children's growth and development.
- Understanding growth patterns in different CP phenotypes is crucial for management.
- Unilateral and bilateral CP present distinct clinical characteristics.
Purpose of the Study:
- To compare growth trajectories in infants, children, and adolescents with unilateral versus bilateral CP.
- To investigate the association of growth patterns with gross motor function, dysphagia, and gestational age.
Main Methods:
- Retrospective study of 389 children with CP.
- Analysis of 1536 height and weight measurements (6-180 months), z-scored.
- Generalized linear mixed models used to assess associations between growth, CP phenotype, GMFCS, dysphagia, and gestational age.
Main Results:
- Bilateral CP phenotype was significantly associated with lower height, weight, and BMI z-scores compared to unilateral CP.
- Children with bilateral CP and GMFCS III-V or dysphagia exhibited more pronounced growth deficits.
- Preterm birth did not show a significant association with reduced growth in this cohort.
Conclusions:
- Bilateral CP is associated with significantly reduced growth, unlike unilateral CP.
- Moderate to severe gross motor impairment (GMFCS III-V) and dysphagia strongly correlate with reduced growth in bilateral CP.
- Growth monitoring and targeted interventions are essential for children with bilateral CP, especially those with motor and swallowing impairments.
Abstract:
To compare growth patterns during infancy, childhood and adolescence in children with unilateral and bilateral cerebral palsy (CP) phenotype and to assess the association with gross motor impairment, dysphagia and gestational age. We retrospectively studied 389 children with CP from a single center population in Munich, Germany. 1536 measurements of height and weight were tabulated and z-scored from 6 to 180 months of age. Generalized linear mixed model were used to examine the association between growth, GMFCS, dysphagia and gestational age by CP phenotype. Children with unilateral CP tend to grow similarly to their typically developed peers. In the main effect model, bilateral CP phenotype was significantly associated with decreased mean z-scores for height (β [95% CI] - 0.953 [- 1.145, - 0.761], p < 0.001), weight (- 0.999 [- 1.176, - 0.807], p < 0.001) and BMI (β [95% CI] - 0.437 [- 0.799, - 0.075]), compared with unilateral CP phenotype. This association remained significant in the interaction models. The height-for-age z-scores, weight-for-age decreased z-scores and BMI-for-age z-scores of children with bilateral CP and GMFCS III-V or dysphagia decreased more significantly than those of children with unilateral CP. Preterm birth was not significantly associated with decreased growth in height, weight and BMI. Reduced growth in children with bilateral CP was strongly associated with moderate to severe impairment in gross motor function (GMFCS III-V) and dysphagia.
