Nutritional Assessment and Intervention in Children with Cerebral Palsy (Clinical Audit)

Abstract
Background: Neurologically Impaired (NI) children are at increased risk of malnutrition due to several nutritional and non-nutritional factors. Among nutritional factors, insufficient dietary intake as a consequence of feeding difficulties is one of the main issues. Feeding problems are frequently secondary to oropharyngeal dysphasia, which usually correlates with the severity of motor impairment and presents in around 90% of preschool children with Cerebral Palsy (CP) during the first year of life. Other nutritional factors are represented by excessive nutrient losses, often subsequent to gastro esophageal reflux and altered energy metabolism. Among the non-nutritional factors, the type and severity of neurological impairment, ambulatory status, the degree of cognitive im-pairment, and use of antiepileptic medication altogether concur to determination of nutritional status.
Aim: To assess the degree of adherence of medical staff at neurology unit to new guidelines for nutritional assessment and intervention of children with cerebral palsy.
Patients and Methods: The study included all cerebral palsy children admitted at Neurology Unit Assiut University Children Hospital from 1st of January to 30th of June 2017. An observational checklist based on new guidelines developed by the investigators in order to assess the degree of adherence of medical staff at Neurology Unit at Assiut University Children Hospital to protocol for nutritional assessment and intervention in children with cerebral palsy according to this new guidelines.
Results: The study included 101 cerebral palsy children, their age ranged from 1 month to 15 years, 65 cases were males and 36 were females.
•Children who need no intervention were 7.9% of cases.
•Children who need to increase caloric intake were 19.8% of cases.
•Children who need to micronutrient supplementation were 19.8% of cases.
•Children who need to increase caloric intake and micronu-trient supplementation were 14.9% of case.
•Children who need to insert gastrostomy tube were 37.6% of cases.
Conclusion: Malnutrition is a frequent complication in CP children impacting on overall health and quality of life. Severity of feeding issues generally increases with reduction of general motor function and cognitive ability. Nutritional assessment and support should be an integral part of the care of CP children aiming at early identification of children at risk of nutrition-related co morbidities. To ensure success of interventions, close monitoring of nutritional status should be performed by a multidisciplinary team.