Campanozzi Angelo, Capano Guglielmo, Miele Erasmo, Romano Alfonso, Scuccimarra Goffredo, Del Giudice Ennio, Strisciuglio Caterina, Militerni Roberto, Staiano Annamaria
Department of Pediatrics, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
Brain Dev. 2007 Jan;29(1):25-9. doi: 10.1016/j.braindev.2006.05.008. Epub 2006 Jul 14.
Children with cerebral palsy (CP) often demonstrate abnormal feeding behaviours, leading to reduced food consumption and malnutrition. Moreover, most of them present with gastrointestinal disorders, such as gastroesophageal reflux disease (GERD) and/or chronic constipation (CC), and poor motor function rehabilitation. The aim of our study was to assess the possible relationship between malnutrition and gastrointestinal problems and to evaluate the role of nutrition on their gross motor abilities in a population of children with CP and mental retardation.
Twenty-one consecutive children (10 boys; mean age: 5.8+/-4.7 years; range: 1-14 years) with CP and severe mental retardation.
Nutritional assessment included the measurement of body mass index (BMI=W/H2), fat body mass (FBM) and fat free mass (FFM). Children with symptoms suggesting GERD underwent prolonged 24h intraesophageal pH monitoring and/or upper GI endoscopy with biopsies before and after a 6 months of pharmaceutical (omeprazole) and nutritional (20% increment of daily caloric intake) treatments. The motor function was evaluated by "The Gross Motor Function Measure" (GMFM) before and after the 6 months on nutritional rehabilitation.
BMI for age was <or=5 degrees percentile in 11 children (52%) and FBM was <or=80% of ideal value for height in 15 (71%). GERD was present in 14 children (67%), 9 of them were affected by both GERD and CC. Among children with FBM <or= 80%, GERD was present in 11 (73%) and CC in 9 (60%). Considering the group of patients with BMI <or= 5 degrees percentile, 9 out of 11 children had GERD (82%) and 7 had CC (64%). Fourteen malnourished children (FBM <or= 80%) completed the 6 months nutritional trial. Their starting and final means+/-SD BMI were 13.56+/-1.31 and 14.15+/-1.85 (p=0.08), respectively. GMFM values were significantly (p<0.05) improved in 9/14 pts (Group A), while it remained unchanged in 5/14 pts (Group B). Nine children with GERD and malnutrition completed the 6 months of pharmaceutical and nutritional treatments. Their initial mean+/-SD weight was 10.1+/-2.9 kg, whereas the final mean+/-SD weight was 12.7+/-4 kg (p<0.05). A marked improvement of GERD was noted in four of nine (44.4%) children. Despite successful nutritional rehabilitation with a BMI achievement of >or=25 degrees percentile, five of nine (55.5%) patients had persistent GERD when they were taken off the medication.
Malnutrition and gastrointestinal disorders are very common in children with cerebral palsy. Improved nutritional status, particularly fat free mass gain, appears to have an impact on motor function in children with CP.
脑瘫（CP）患儿常表现出异常的进食行为，导致食物摄入量减少和营养不良。此外，他们中的大多数还存在胃肠道疾病，如胃食管反流病（GERD）和/或慢性便秘（CC），以及运动功能康复不佳的问题。我们研究的目的是评估营养不良与胃肠道问题之间可能存在的关系，并评估营养在脑瘫和智力障碍患儿总体运动能力方面所起的作用。
21例连续入选的患有脑瘫和严重智力障碍的儿童（10名男孩；平均年龄：5.8±4.7岁；范围：1 - 14岁）。
营养评估包括测量体重指数（BMI = 体重/身高²）、脂肪量（FBM）和去脂体重（FFM）。有GERD症状的儿童在接受6个月的药物（奥美拉唑）和营养（每日热量摄入增加20%）治疗前后，进行长达24小时的食管pH监测和/或上消化道内镜检查及活检。在营养康复6个月前后，通过“粗大运动功能测量”（GMFM）评估运动功能。
11名儿童（52%）的年龄别BMI处于≤第5百分位，15名（71%）儿童的FBM≤理想身高值的80%。14名儿童（67%）存在GERD，其中9名同时患有GERD和CC。在FBM≤80%的儿童中，11名（73%）存在GERD，9名（60%）存在CC。在BMI≤第5百分位的患儿组中，11名儿童中有9名（82%）患有GERD，7名（64%）患有CC。14名营养不良儿童（FBM≤80%）完成了6个月的营养试验。他们开始和最后的平均±标准差BMI分别为13.56±1.31和14.15±1.85（p = 0.08）。14名患儿中有9名（A组）的GMFM值显著改善（p < 0.05），而5名（B组）患儿的GMFM值保持不变。9名患有GERD和营养不良的儿童完成了6个月的药物和营养治疗。他们最初的平均±标准差体重为10.1±2.9千克，而最后的平均±标准差体重为12.7±4千克（p < 0.05）。9名儿童中有4名（44.4%）的GERD有明显改善。尽管通过营养康复成功使BMI达到≥第25百分位，但9名患者中有5名（55.5%）在停药后仍存在持续性GERD。
营养不良和胃肠道疾病在脑瘫患儿中非常常见。营养状况的改善，特别是去脂体重的增加，似乎对脑瘫患儿的运动功能有影响。
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