Benfer Katherine A, Weir Kelly A, Ware Robert S, Davies Peter S W, Arvedson Joan, Boyd Roslyn N, Bell Kristie L
Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.
Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia.
Dev Med Child Neurol. 2017 Nov;59(11):1181-1187. doi: 10.1111/dmcn.13498. Epub 2017 Sep 6.
To determine the most accurate parent-reported indicators for detecting (1) feeding/swallowing difficulties and (2) undernutrition in preschool-aged children with cerebral palsy (CP).
This was a longitudinal, population-based study, involving 179 children with CP, aged 18 to 60 months (mean 34.1mo [SD 11.9] at entry, 111 males, 68 females [Gross Motor Function Classification System level I, 84; II, 23; III, 28; IV, 18; V, 26], 423 data points). Feeding/swallowing difficulties were determined by the Dysphagia Disorders Survey and 16 signs suggestive of pharyngeal phase impairment. Undernutrition was indicated by height-weight and skinfold composite z-scores less than -2. Primary parent-reported indicators included mealtime duration, mealtime stress, concern about growth, and respiratory problems. Other indicators were derived from a parent feeding questionnaire, including 'significant difficulty eating and drinking'. Data were analysed using multilevel mixed-effects regression and diagnostic statistics.
Primary parent-reported indicators associated with feeding/swallowing were 'moderate-severe parent stress' (odds ratio [OR]=3.2 [95% confidence interval {CI} 1.3-7.8]; p<0.01), 'moderate-severe concern regarding growth' (OR=4.5 [95% CI 1.7-11.9]; p<0.01), and 'any respiratory condition' (OR=1.8 [95% CI 1.4-5.8]; p<0.01). The indicator associated with undernutrition was 'moderate-severe concern regarding growth' (height-weight OR=13.5 [95% CI 3.0-61.3]; p<0.01; skinfold OR=19.1 [95% CI 3.7-98.9]; p<0.01). 'Significant difficulty eating and drinking' was most sensitive/specific for feeding outcome (sensitivity=58.6%, specificity=100.0%), and 'parent concern regarding growth' for undernutrition (sensitivity=77.8%, specificity=77.0%).
Parent-reported indicators are feasible for detecting feeding and swallowing difficulties and undernutrition in children with CP, but need formal validation.
Parent-reported indicators can detect feeding/swallowing difficulties and undernutrition in children with cerebral palsy. Most accurate screening questions were 0-10 scales for 'difficulty eating' and 'difficulty drinking'. Supplementation of these scales with additional indicators would improve detection.
确定用于检测（1）脑瘫（CP）学龄前儿童喂养/吞咽困难和（2）营养不良的最准确的家长报告指标。
这是一项基于人群的纵向研究，涉及179名CP儿童，年龄在18至60个月之间（入组时平均34.1个月[标准差11.9]，男111名，女68名[粗大运动功能分类系统Ⅰ级84名；Ⅱ级23名；Ⅲ级28名；Ⅳ级18名；Ⅴ级26名]，423个数据点）。通过吞咽障碍调查和16项提示咽期受损的体征确定喂养/吞咽困难。身高体重和皮褶综合z评分小于-2表明存在营养不良。家长报告的主要指标包括进餐时间、进餐压力、对生长的担忧以及呼吸问题。其他指标来自家长喂养问卷，包括“饮食存在显著困难”。使用多级混合效应回归和诊断统计分析数据。
与喂养/吞咽相关的家长报告主要指标为“中度至重度家长压力”（优势比[OR]=3.2[95%置信区间{CI}1.3 - 7.8]；p<0.01）、“对生长的中度至重度担忧”（OR=4.5[95%CI 1.7 - 11.9]；p<0.01）以及“任何呼吸状况”（OR=1.8[95%CI 1.4 - 5.8]；p<0.01）。与营养不良相关的指标是“对生长的中度至重度担忧”（身高体重OR=13.5[95%CI 3.0 - 61.3]；p<0.01；皮褶OR=19.1[95%CI 3.7 - 98.9]；p<0.01）。“饮食存在显著困难”对喂养结果最敏感/特异（敏感性=58.6%，特异性=100.0%），“家长对生长的担忧”对营养不良最敏感/特异（敏感性=77.8%，特异性=77.0%）。
家长报告指标对于检测CP儿童的喂养和吞咽困难及营养不良是可行的，但需要正式验证。
家长报告指标可检测脑瘫儿童的喂养/吞咽困难和营养不良。最准确的筛查问题是关于“进食困难”和“饮水困难”的0 - 10分量表。用其他指标补充这些量表将提高检测效果。
