Serebral Palsili hastalarda fonksiyonel durum, Serebral palsi tipi ve antropometrik parametrelerin ilişkisi

Abstract

Giriş: Serebral palsili çocuklarda büyüme geriliği çok yaygın olup en önemli nedeni malnutrisyondur. Çalışmanın amacı serebral palsili hastaların demografik yapılarını ortaya koymak ve büyüme geriliğine etkili faktörleri tartışmaktır. Gereç ve yöntem: Çalışmaya hastanemizde yatarak rehabilitasyon programı alan 48 serebral palsi tanısı almış, 2-14 yaş arası hasta dahil edildi. Hastaların yaş, cinsiyet, etyoloji, klinik SP tipi ve eşlik eden sorunları kaydedildi. Hastaların fonksiyonel durumları Gross motor function classification system (GMFCS)’e göre belirlendi. Beslenme problemi veya beslenme desteği olup olmadığı, günlük kalori ihtiyacı belirlendi. Hastaların boy, kilo, baş çevresi, kol çevresi ölçümleri yapıldı, vücut kitle indeksleri (VKI) hesaplandı. Bulgular: Hastaların %56.2’si kız ve %43.8’i erkek ve yaş ortalaması 6.031±2.7 (2.3-13.5) yıl idi. Hastalar klinik tiplere göre ayrıldığında 19(39.6) hasta diplejik ve 29(%60.4) hasta kuadriplejik tipti. 28(%58.3) hasta non –ambule ve 19(%41.7) ambule idi.Hastaların baş çevresi 48.1±7.5 cm, kol çevresi 16.4±2.6 cm, kalça çevresi 52.1±5.9, bacak uzunluğu 22.8±3.5 ve cilt kalınlığı 22.4±1.1 cm olarak ölçüldü. Boy ve kilo persentili 10 ve altında olan hastalar sırasıyla %63.8 ve %57.4 ve vücut ağırlık persentiline (VAP) göre 15 ve altında olan hasta %48.9 idi. Hastalarda beslenme problemleri olarak sırasıyla %6.3 gastro-özofagieal reflü, %14.6 yutma güçlüğü, %33.3 salya akıtma ve % 68.8 diş problemi tespit edildi. Hastaların %56.3’ü beslenme desteği (pediasure) kullanıyordu. Aynı şekilde hastaların annelerinin %93.8’i ev hanımı ve %62.5’i ilkokul mezunu idi. Sonuç: Büyüme geriliği normal populasyona kıyasla serebral palsi hastalarında yaygındır. Malnutrisyon en sık görülen nedeni olup, bunun için de birçok risk faktörü mevcuttur.

Keywords

• serebral palsi
• malnutrisyon
• büyüme geriliği

Relationship between functional status, Cerebral palsy subtype and anthropometric parametres in Cerebral Palsied children

Abstract

Growth retardation is shown in patients with cerebralpalsy (CP) and most important cause is be malnutrition. The aim of the current study is to reveal socio-demographic characteristics of CP patients and relationship between anthropometric parametres and functionality. Material and Methods: Total of 48 CP patients, between 2-14 years-old admitted to our inpatient clinic, are included in the study. Age, gender, etiology, CP subtype and co-morbidities were recorded. Functional status of the children were recorded according to the Gross motor function classification system (GMFCS). Weight, height measurements were done, body mass index (BMI) and Z-scores were calculated. Results: Of the patients 56.2% were female and 43.8% were male with 6.0±2.7 (2.3-13.5) (mean±SD) years mean age. Totally, 19 patients (39.6%) were classified as diplegic and 29 patients (60.4%) were classified as total type CP. Total of 28 (58.3%) patients were non-ambulatory and 20 (41.7%) patients were ambulatory. Patients with height and weight 3th percentile and below were 46.3% and 34% of all, respectively. The BMI percentile of the patients accoding to the 5th percentile and below were 31.9% of total. Of the patients 68.8% had teeth problems, 33.3% had sialorrhea, 14.6% had dysphagia and 6.3% had gastro-esophageal reflux as nutritional problems. Conclusion: Growth retardation is more common in patients with cerebral palsy and has multiple reasons. Nutritional parameters is used to assess growth. We did not detect significant difference between functionality, CP type and body weight, height and BMI Z- scores in CP patients.

Keywords

• Body height
• Malnutrition
• Cerebral palsy
• Body weight

References

1. 1. Kong CK, Wong HSS. Weight-for-height values and limb anthropometric composition of tube-fed children with quadriplegic cerebral palsy. Pediatrics 2005;116:e839
2. 2. Stevenson RD, Hayes RP, Cater LV, Blackman JA. Clinical correlates of linear growth in children with cerebral palsy. Dev Med Child Neurol 1994;36:135–42.
3. 3. Stanek JL, Emerson JA, Murdock FA, Petroski GF. Growth characteristics in cerebral palsy subtypes: a comparative assessment. Dev Med Child Neurol. 2016;58:931-5. doi: 10.1111/dmcn.13116. Epub 2016 Apr 5. PubMed PMID: 27059686.
4. 4. Day SM, Strauss DJ, Vachon PJ, Rosenbloom L, Shavelle RM,Wu YW. Growth patterns in a population of children adolescents with cerebral palsy. Dev Med Child Neurol 2007;49:167–71.
5. 5. Dahlseng MO, Finbråten AK, Júlíusson PB, Skranes J, Andersen G, Vik T. Feeding problems, growth and nutritional status in children with cerebral palsy. Acta Paediatr. 2012;101:92-8. doi: 10.1111/j.1651-2227.2011.02412.x. Epub 2011 Aug 2. PubMed PMID: 21767308.
6. 6. Stallings VA, Charney EB, Davis JC, Cronk CE. Nutrition-relatedgrowth failure of children with quadriplegic CP. Dev Med ChildNeurol 1993c;35:126–38.
7. 7. Henderson CJ, Lovell DJ, Specker BL, Campaigne BN. Physicalactivity in children with juvenile rheumatoid arthritis: quantificationand evaluation. Arthritis Care Res 1995;8:114–19
8. 8. Dahl M1, Thommessen M, Rasmussen M, Selberg T. Feeding and nutritional characteristics in children with moderate or severe cerebral palsyActa Paediatr. 1996 ;85:697-701.

9. 9. Penagini F, Mameli C, Fabiano V, Brunetti D, Dilillo D, Zuccotti GV. Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients. 2015: 13;7:9400-15. doi: 10.3390/nu7115469. Review.PubMed PMID: 26580646;PubMed Central PMCID: PMC4663597.
10. 10. Melunovic M, Hadzagic-Catibusic F, Bilalovic V, Rahmanovic S, Dizdar S.Anthropometric Parameters of Nutritional Status in Children with Cerebral Palsy. Mater Sociomed. 2017;29:68-72. doi: 10.5455/msm.2017.29.68-72. PubMed PMID: 28484358; PubMed Central PMCID: PMC5402377
11. 11. Tomoum HY, Badawy NB, Hassan NE, Alian KM. Anthropometry and body composition analysis in children with cerebral palsy. Clin Nutr. 2010;29:477–481. doi: 10.1016/j.clnu.2009.10.009. [PubMed] [Cross Ref]
12. 12. Roche AF, Mukherjee D, Guo SM, Moore WM. Head circumference reference data: birth to 18 years. Pediatrics. 1987 ;79:706-12. PubMed PMID: 3575026.
13. 13. Frisancho AR.New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981;34:2540-5
14. 14. NCHS. Analytic and reporting guidelines: the third national health and nutrition examination survey, NHANES III (1988–94). Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention; 1996.
15. 15. Beker L. Principles of growth assessment. Pediatr Rev. 2006;27:196-7; discussion 197-8. Review. PubMed PMID: 16651277.
16. 16. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, Baş F. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 1-14.
17. 17. Pascoe J, Thomason P, Graham HK, Reddihough D, Sabin MA. Body mass index in ambulatory children with cerebral palsy: A cohort study. J Paediatr Child Health. 2016;52:417-21. doi: 10.1111/jpc.13097. PubMed PMID: 27145505.
18. 18. Sullivan PB, Alder N, Bachlet AM, Grant H, Juszczak E, Henry J, Vernon-Roberts A, Warner J, Wells J. Gastrostomy feeding in cerebral palsy: too much of a good thing? Dev Med Child Neurol. 2006;48:877-82. PubMed PMID: 17044953.
19. 19. Zainah SH, Ong LC, Sofiah A, Poh BK, Hussain IH. Determinants of linear growth in Malaysian children with cerebral palsy. J Paediatr Child Health 2001;37:376–81
20. 20. Henderson RC, Lark RK, Gurka MJ, Worley G, Fung EB, Conaway M et al. Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrics 2002;10:e5
21. 21. Kakooza-Mwesige A, Tumwine JK, Eliasson AC, Namusoke HK, Forssberg H. Malnutrition is common in Ugandan children with cerebral palsy, particularly those over the age of five and those who had neonatal complications. Acta Paediatr. 2015;104:1259-68. doi: 10.1111/apa.13089. Epub 2015 Aug 7.PubMed PMID: 26088908; PubMed Central PMCID: PMC5042112.
22. 22. Voss W, Jungmann T, Wachtendorf M, Neubauer AP. Long-term cognitive outcomes of extremely low-birth-weight infants: the influence of the maternal educational background. Acta Paediatr 2012;101:569–73.
23. 23. Koutra K, Chatzi L, Roumeliotaki T, et al. Socio-demographic determinants of infant neurodevelopment at 18 months of age: Mother-Child Cohort (Rhea Study) in Crete, Greece. Infant Behav Dev 2012;35:48–59.
24. 24. Solaski M, Majnemer A, Oskoui M. Contribution of socio-economic status on the prevalence of cerebral palsy: a systematic search and review. Dev Med Child Neurol. 2014;56:1043-51. doi: 10.1111/dmcn.12456. Epub 2014 Apr 19.Review. PubMed PMID: 24750064.
25. 25. Johnson A, Gambrah-Sampaney C, Khurana E, Baier J, Baranov E, Monokwane B,Bearden DR. Risk Factors for Malnutrition Among Children With Cerebral Palsy in Botswana. Pediatr Neurol. 2017 ;70:50-55. doi: 10.1016/j.pediatrneurol.2017.02.003. Epub 2017 Feb 14. PubMed PMID: 28363511.