Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
Hosp Pediatr. 2020 Dec;10(12):1087-1095. doi: 10.1542/hpeds.2020-0177. Epub 2020 Nov 5.
Children with cerebral palsy (CP) and other medical complexity comprise an outsized proportion of health care use. In this review, we describe the current science of assessment of nutritional status for children with CP, outline a systematic approach to assessing their nutritional status, delineate ramifications of malnutrition on hospitalization-associated outcomes, and identify knowledge gaps and means of addressing those gaps using quality improvement and clinical research tools. Methods to accurately assess body composition and adiposity in this population by using skinfolds, age, sex, and activity level are available but are not widely used. There are limitations in our current method of estimating energy needs in children with CP, who are at higher risk of both obesity and micronutrient deficiencies. There is some evidence of an association between malnutrition, defined as either underweight or obesity, and hospitalization-associated outcomes in children generally, although we lack specific data for CP. The gaps in our current understanding of optimal nutritional status and between current science and practice need to be addressed to improve health outcomes for this vulnerable patient population.
患有脑瘫（CP）和其他医学复杂性的儿童在医疗保健利用方面占比过高。在这篇综述中，我们描述了 CP 儿童营养状况评估的现有科学，概述了评估其营养状况的系统方法，阐述了营养不良对与住院相关的结局的影响，并确定了利用质量改进和临床研究工具来解决这些差距的知识空白。有一些方法可以通过皮褶、年龄、性别和活动水平来准确评估这一人群的身体成分和体脂，但这些方法尚未得到广泛应用。我们目前估算 CP 儿童能量需求的方法存在局限性，因为他们肥胖和微量营养素缺乏的风险更高。有一些证据表明，营养不良（定义为体重过轻或肥胖）与一般儿童的住院相关结局之间存在关联，但我们缺乏 CP 儿童的具体数据。我们需要解决当前对最佳营养状况的理解差距以及当前科学与实践之间的差距，以改善这一脆弱患者群体的健康结局。
