Pediatric Department, Pediatric Neuropsychiatry Unit, Faculty of Medicine, Ain Shams University, Abbassia Square, P.O.Box 11381, Cairo, Egypt.
Ministry of Health, Cairo, Egypt.
World J Pediatr. 2021 Feb;17(1):92-98. doi: 10.1007/s12519-020-00401-0. Epub 2021 Jan 22.
Constipation is a common problem in children with spastic cerebral palsy (sCP) with a prevalence that reaches 75%. We hypothesized that treating constipation in those children will improve their health and shorten time spent in daily care. Our aim was to evaluate the efficacy and safety of oral magnesium sulfate for treating chronic constipation in children with sCP.
A prospective, double-blinded randomized control trial was carried out involving 100 children aged 2-12 years with sCP (level III-V of the Gross Motor Functional Classification system) and chronic constipation. They were followed up in the Pediatric neurology clinic, Children's hospital, Ain Shams University, May 2017- January 2019. The intervention group (O-Mg) received oral magnesium sulfate 1 mL/kg/day daily for 1 month compared to the placebo. Outcome measures were constipation improvement and decrease in bowel evacuation time after 1 month.
Initially, weekly bowel movements, constipation scores and stool consistency were comparable in both groups. After 1 month of regular administration of oral magnesium sulfate, the constipation score, stool frequency and consistency improved compared to the placebo group (P < 0.001). Effective safe treatment was achieved in 31 (68%) and 4 (9.5%) patients in the O-Mg and placebo groups, respectively (RR, 2.95; 95% CI 2.0-4.5) (P < 0.001). Painful bowel evacuation attempts spent by mothers decreased from 25 (55.6%) of the cases initially to 10 (22%) cases after one month in the O-Mg group (P = 0.001). In contrast, in the placebo group, the decrease went from 21 (50%) cases initially to 18 (42.9%) after 1 month and was not significant (P = 0.5).
Oral magnesium sulfate seems effective in alleviating chronic constipation and pain experience in children with sCP. Consequently, saving maternal time spent in daily bowel evacuation attempts.
痉挛性脑瘫（sCP）患儿常伴有便秘，其患病率高达 75%。我们推测治疗这些患儿的便秘将改善他们的健康状况并缩短日常护理时间。我们旨在评估口服硫酸镁治疗 sCP 患儿慢性便秘的疗效和安全性。
我们开展了一项前瞻性、双盲随机对照试验，纳入了 2017 年 5 月至 2019 年 1 月在艾因夏姆斯大学儿童医院儿科神经病学诊所就诊的 100 例年龄为 2-12 岁、患有 sCP（运动功能分级系统 III-V 级）和慢性便秘的患儿。干预组（O-Mg 组）接受 1 毫升/千克/天的口服硫酸镁治疗，疗程为 1 个月，而安慰剂组则接受安慰剂治疗。观察指标为治疗 1 个月后便秘改善情况和排便时间的变化。
治疗前，两组患儿的每周排便次数、便秘评分和粪便稠度相似。在接受 1 个月的硫酸镁治疗后，O-Mg 组的便秘评分、排便频率和粪便稠度均优于安慰剂组（P<0.001）。O-Mg 组和安慰剂组的有效治疗率分别为 31 例（68%）和 4 例（9.5%）（RR，2.95；95%CI 2.0-4.5）（P<0.001）。O-Mg 组母亲报告的排便费力尝试次数从初始的 25 例（55.6%）减少到治疗 1 个月后的 10 例（22%）（P=0.001）。相比之下，安慰剂组的这一数字从初始的 21 例（50%）减少到治疗 1 个月后的 18 例（42.9%），但无统计学意义（P=0.5）。
口服硫酸镁治疗 sCP 患儿慢性便秘和减轻疼痛有效，因此可减少母亲日常排便护理时间。
