Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Dev Med Child Neurol. 2012 Oct;54(10):938-44. doi: 10.1111/j.1469-8749.2012.04391.x. Epub 2012 Jul 31.
To compare the prevalence of gastrostomy tube feeding (GTF) of children with cerebral palsy (CP) in six European countries.
Data on 1295 children (754 males, 541 females; mean age 5y 11mo, range 11y 2mo, min 6mo, max 11y 8mo) with CP born from 1999 to 2001 were collected from geographically defined areas in six European countries; four of the areas covered the whole country. Distribution of CP was unilateral 37%, bilateral 51%, dyskinetic 8%, and ataxic 4%. Sixty children were classified in Gross Motor Function Classification System (GMFCS) levels I and II, 6 in level III and 34 in levels IV and Vas Outcome measures were GTF, age at placement, feeding difficulties and the children's height and weight for age standard deviation scores (z-scores).
The use of GTF among all children with CP was highest in western Sweden (22%, 95% confidence interval [CI] 16-29), and lowest in Portugal (6%, 95% CI 3-10), northern England (6%, 95% CI 3-9) and in Iceland (3%, 95% CI 0-13; p<0.001). The difference between areas was greater among children in GMFCS levels IV and V (non-ambulant); in this group, lower height z-scores were more prevalent in the areas with lower prevalence of GTF. The children's age at placement of gastrostomy also varied between areas (p<0.002).
The observed differences in the use of GTF may reflect differences in access to treatment or clinical practice, or both. Our results suggest that the use of GTF may improve growth in height and weight among children with more severely affected gross motor function - the group most likely to have associated feeding difficulties.
比较 6 个欧洲国家脑瘫儿童胃造口管喂养（GTF）的流行率。
从 6 个欧洲国家地理定义的区域收集了 1295 名（男 754 名，女 541 名；平均年龄 5 岁 11 个月，范围 11 岁 2 个月，最小 6 个月，最大 11 岁 8 个月）1999 年至 2001 年出生的脑瘫儿童的数据；其中 4 个区域覆盖整个国家。脑瘫分布为单侧 37%，双侧 51%，运动障碍 8%，共济失调 4%。60 名儿童被归类为粗大运动功能分类系统（GMFCS）水平 I 和 II，6 名儿童为水平 III，34 名儿童为水平 IV 和 V。结果测量包括 GTF、置管年龄、喂养困难以及儿童的身高和体重年龄标准差评分（z 评分）。
所有脑瘫儿童中，GTF 的使用率在瑞典西部最高（22%，95%置信区间 [CI] 16-29%），葡萄牙最低（6%，95% CI 3-10%），英格兰北部（6%，95% CI 3-9%）和冰岛（3%，95% CI 0-13%；p<0.001）。GMFCS 水平 IV 和 V（非步行）儿童之间的地区差异更大；在这一组中，GTF 使用率较低的地区，身高 z 评分较低的情况更为普遍。胃造口置管的儿童年龄也因地区而异（p<0.002）。
GTF 使用的差异可能反映了治疗或临床实践的可及性或两者都有差异。我们的结果表明，GTF 的使用可能会改善运动功能严重受损的儿童的身高和体重增长——这是最有可能存在相关喂养困难的群体。
