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Growth of severely impaired children: neurological versus nutritional factors
Insights
Gastrostomy feeding significantly improved growth and nutritional status in children with cerebral palsy. This intervention addresses nutritional dysfunction, leading to better weight-for-height ratios in most patients.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Clinical Nutrition
Background:
- Children with cerebral palsy often experience growth failure.
- Distinguishing between neurological and nutritional causes of growth impairment is crucial.
Purpose of the Study:
- To assess the impact of gastrostomy feeding on growth in children with cerebral palsy.
- To determine if nutritional dysfunction contributes to growth failure in this population.
Main Methods:
- Retrospective review of 19 children with cerebral palsy and gastrostomies.
- Analysis of pre- and post-operative weight-for-height Z-scores.
- Assessment of growth parameters over a mean follow-up of 23.1 months.
Main Results:
- Mean weight-for-height Z-score improved from -2.71 preoperatively to -1.18 postoperatively.
- 16 out of 19 children showed an increased weight-for-height ratio.
- Nutritional status improvement did not correlate with follow-up duration.
Conclusions:
- Nutritional factors play a significant role in growth failure for severely neurologically impaired children.
- Gastrostomy feeding can lead to adequate growth and improved nutritional status.
- Ensuring sufficient caloric intake via gastrostomy is vital for growth in pediatric cerebral palsy patients.
Abstract:
Nineteen children with cerebral palsy who have had gastrostomies since 1981 and who have been followed for at least six months postoperatively were reviewed to assess the effects of gastrostomy feeding on their growth and to determine whether growth failure was due to neurological or nutritional dysfunction. The children's ages ranged from five to 168 months (mean 60.4 months) and follow-up extended from six to 41 months (mean 23.1 months). All were profoundly handicapped, with involvement of all four limbs. 11 also had seizures and all 19 were severely to profoundly retarded. Heights and weights were recorded during the visit immediately before surgery and at most recent follow-up. Data were recorded as a standard deviation score (Z-score). Before surgery the mean weight/height was -2.71 Z. Postoperatively this improved to -1.18 Z. 16 of the 19 children increased their weight/height ratio. Three children had a weight/height ratio greater than 10th percentile preoperatively. 11 achieved this on follow-up. Seven children were greater than 25th percentile for weight/height. Improvement in weight/height did not correlate with length of follow-up. For severely neurologically impaired children, nutritional factors play a major rôle in growth. By ensuring adequate caloric intake via gastrostomy, a significant number of children achieved adequate growth and better nutritional status.