الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 281 |  |  |
| | | from | 281 | | |
Abstract
Cerebral palsy is a common cause of physical disability in children, and evidence suggests that children with CP are particularly vulnerable to malnutrition, which may be due to factors such as dysregulation of growth hormone secretion and muscle spasticity. Additionally, feeding difficulties, including oral-motor impairments affecting chewing, food ingestion, and self-feeding, are common and often severe. These difficulties may negatively affect the responsiveness of caregiver feeding practices, further reducing nutritional intake. At the same time, malnutrition may exacerbate physical and cognitive functional limitations among children with CP through reduced muscle strength, lower immunity and cerebral development, and other negative impacts on general health. The initial step in recognizing CP patients who may be prone to nutritional difficulties or who may have undiagnosed malnourishment is nutrition screening. This process assists in averting nutrition-associated problems by detecting the risks and intervening early when these problems are confirmed. The present study aimed to screen the nutritional status of children with cerebral palsy at Tanta University Hospitals. The current study included 100 pediatric patients of both sexes with cerebral palsy, diagnosed by history and clinical examination according to the suggested definition of CP, who were under 17 years old and attended the Pediatric Neurology and Nutrition Clinics, Pediatric Department, Tanta University Hospitals, from August 2021 to August 2023. Exclusion criteria: Children whose parents refused participation or those with certain medical conditions were excluded from the study. These conditions include progressive neurological disorders, structural malformations, syndromic associations, chromosomal anomalies, dysmorphism, and chronic systemic illnesses like congenital heart disease or chronic kidney disease. All children included in the study were subjected to: Through history taking including personal history, perinatal history, past history and cause of the insult if known, family history, developmental history, and the socioeconomic status of the family, Complete dietetic history including feeding methods, weaning history, 24-hour dietary recall, and red flags suggesting feeding/swallowing disorders. Complete physical and neurological examination including assessment of the state of hydration, identification of the type of CP, and assessment of severity of the motor functional impairment using GMFCS. Anthropometric measurements (weight, height, BMI, skin fold thickness, and mid-arm circumference) and plotting the data obtained on the corresponding growth charts. Assessment of the severity of malnutrition of the studied patients using the subjective global nutritional assessment and the Waterlow classifications of malnutrition The results of the present study revealed the followings Regarding the demographic data : The most frequent age group of the studied CP patients was the age group > 6 to 12 years (46%), followed by the age group > 2 to 6 years (35%). Fifty-nine percent (59%) of children were male, whereas 41% were female. Twenty-one percent (21%) of children had positive consanguinity. The socioeconomic status score was low, moderate, or high in 16.0%, 53.0%, and 31.0% of the studied patients, respectively. The majority of the patients (55%) were spastic-diplegic. Eighteen percent (18%) of the patients were dyskinetic (dystonic), 16% were spastic quadriplegics, and 11% were spastic hemiplegics. According to the gross motor function classification system, the highest frequencies were at levels V and III (43% and 28%, respectively), 17% were at level IV, and the lowest frequencies were at levels II and I (11% and 1%, respectively). Asphyxia was the most frequently occurring risk factor for cerebral palsy (74%), followed by respiratory distress (31%), preterm labor (21%), and hyperbilirubinemia (12%), in addition to multiple pregnancies (8%). Sixty-one (61%) of the studied CP patients did not receive antiepileptic drugs (AEDs), 23% were on a single AED, and 16% received double AEDs. The most common antiepileptic drug used was valproate (28%), followed by levetiracetam (18%), topiramate (3%), carbamazepine (2%), and clonazepam (2%). Regarding red flags suggesting feeding and swallowing difficulties Lack of weight gain for 2-3 months was the most frequent sign (74%). Sixty-one percent (61%) of patients had stressful meal times with their caregiver, and about 54% had feeding times longer than 30 minutes, followed by respiratory illnesses (aspiration pneumonia, pharyngeal or laryngeal problems), and the gurgling voice (31% and 8%, respectively). The percentages of patients with no, one, two, three, four, and five red flags were 6 %, 20%, 29%, 25%, 15%, and 5%, respectively. Regarding feeding history The vast majority of the patients (97%) received oral feeding. Seventy-five percent (75%) of them could eat liquid and solid foods (pureed, mashed, minced, or soft-cooked), while, 13% could feed only the liquid form and 12% only the solids. The median daily water intake as a percentage of the DRI was 45%. The median daily energy intake as a percentage of the DRI was 66%. The median daily carbohydrate intake as a percentage of the DRI was 76%, while the median calories derived from carbohydrate sources as a percentage of the total caloric intake was 69%. The median daily protein intake as a percentage of the DRI was 67% while the median calories derived from protein sources, as a percentage of the total caloric intake was 12%. c intake was 12%. The median daily fat intake as a percentage of the DRI was 78%, while the median daily intake of calories derived from fat sources as a percentage of the total calorie intake was 19%. The median daily fiber intake as a percentage of the DRI was 19%. Regarding the gastrointestinal problems Forty percent (40%) of patients had dysphagia, and 23% had mouth ulcers and gingivitis. Regurgitation and vomiting occurred in 14% and 7%, respectively. Thirteen percent of the patients had severe constipation (type I in the Bristol stool chart). Regarding the anthropometric measurements There were significant differences among the distributions of the studied CP patients regarding different anthropometric measurements (weight, length/height, and BMI) using CP-specific, WHO, and Egyptian growth charts. According to CP-GMFCS growth charts About 64.9% of the patients had normal weights, 33% were underweight, and 2.1% were overweight. About 90.4% of the patients had normal heights/lengths, and 9.6% were stunted. Sixty-five 65% of the patients had normal BMIs, 7.4% were wasted, 17% were overweight, and 10.6% were obese. There was a significant positive correlation between the distribution of the patients, based on weight grades, and the levels of gross motor function. There was a significant positive correlation between the distribution of the patients, based on BMI grades, and their socioeconomic status score. According to WHO /CDC growth charts Twenty-four percent (24%) of the patients were severely underweighted, 23% were underweight, 4% were overweight, and 49% had normal weights. Sixty-six percent (66%) of them were severely stunted, 17% were stunted, and 17% had normal lengths/ heights. Forty-four percent (44%) of them had normal BMIs, whereas 8% were severely wasted, 4% were wasted, 6% were at risk of being overweight, 13% were overweight, and 25% were obese. The median value of total body fat percentage was 35%. The median value for each triceps and subscapular skinfold thickness Z score was 0.00, and the median value of the mid-arm circumference Z score was -1.0. According to Egyptian growth charts Thirty-three percent of the patients were severely under-weighted, 16% were underweight, 1% were overweight, and 50% had normal weights. Sixty-five percent of them were severely stunted, 15% were stunted, and 20% had normal heights/lengths. Regarding BMI, 39% had normal BMIs, while 12% were severely wasted, 5% were wasted, 12% were at risk of being overweight, 14% were overweight, and 18% of them were obese. Regarding the severity of malnutrition According to subjective global nutritional assessment Thirty-three (33%) had normal/well nutritional status, whereas 47% had moderate and 20% had severe malnutrition. A significant positive correlation was observed between the distribution of patients, regarding the degree of malnutrition according to SGNA, and types of CP. Among the malnourished patients, 55% with severe malnutrition and 59.6% with moderate malnutrition had spastic diplegia. A significant positive correlation was observed between the distribution of patients, regarding the degree of malnutrition according to SGNA, and the GMFC of CP. Seventy percent (70%) of severely and 38.1% of moderately malnourished patients had level V of GMF A significant inverse correlation was observed between the distribution of patients, regarding the degree of malnutrition revealed by SGNA, and the double use of anti-epileptics. According to Waterlow’s classification The severity of acute malnutrition (wasting) using WHO/CDC charts (WFH) Seventy-six percent (76%) of the patients had normal nutritional status, while 12%, 6%, and 6%, respectively, had mild, moderate, and severe wasting. The severity of chronic malnutrition (stunting) There were significant differences among the distributions of the studied CP patients regarding the degree of stunting using CP, WHO, and Egyptian growth charts. - According to GMFC-CP charts (HFA), About 19.15% had normal nutritional status, 19.15%, 29.79%, and 31.91% had mild, moderate, and severe stunting, respectively. - According to WHO charts (HFA), Seven percent (7%) had normal nutritional status, while 16%, 20%, and 57% had mild, moderate, and severe stunting, respectively. There was a significant positive correlation between the distribution of the patients, based on the degree of stunting according to Waterlow classification, and the age groups of the studied patients. About 54.4% of the severely stunted patients were from the age group >6 to 12 years, while 50% of patients with moderate stunting were from the age group >2 to 6 years. The highest percentage of mildly stunted patients (43.8%) was from the age group ≤ 2 years. - According to Egyptian charts (HFA) Eight percent (8%) had normal nutritional status, while 16%, 17%, and 59% had mild, moderate, and severe malnutrition, respectively. There was a significant positive correlation between the distribution of the patients, based on the degree of stunting according to Waterlow classification, and the age groups of the studied patients. About 55.9% of severely stunted patients were from the age group >6 to 12 years, whereas 52.9% of patients with moderate stunting were from the age group >2-6 years. The age group ≤ 2 years had the highest percentage of mildly stunted patients (43.8%).