Civan Hasret Ayyildiz, Bektas Gonca, Dogan Ali Evrim, Ozdener Fatih
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bakırköy Dr. Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey.
Department of Pediatric Neurology, Bakırköy Dr. Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey.
Neuropediatrics. 2021 Aug;52(4):326-332. doi: 10.1055/s-0041-1731007. Epub 2021 Jun 30.
The prevalence of congenital cerebral palsy (CP) worldwide ranges from 0.15 to 0.4%. CP causes several gastrointestinal complications that inhibit normal eating behavior. This single-center observational study aimed to determine the tolerability and benefits of percutaneous endoscopic gastrostomy (PEG) in pediatric CP patients with malnutrition.
The study included 41 pediatric CP patients with malnutrition. All patient data were retrospectively obtained from Bakırköy Dr. Sadi Konuk Research and Training Hospital, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Istanbul, Turkey. In addition to baseline measurements of weight, height, triceps skinfold thickness, 1,25-hydroxyvitamin D3, folate, iron, zinc, vitamin B12, hemoglobin, and mean corpuscular volume, data analyzed included follow-up measurements recorded at 3 and 6 months of PEG (standard polymeric enteral supplementation as 1.0 kcal mL).
There was significant improvement in both height, weight, and triceps skinfold thickness in all patients at 3 and 6 months of PEG ( < 0.05). In terms of blood parameters, there was not significant improvement, except that the number of patients with a low hemoglobin count significantly decreased at 3 and 6 months of ( = 0.022). Moreover, the number of patients with vomiting after PEG also significantly decreased at 3 and 6 months of ( = 0.004).
PEG significantly improves malnutrition in pediatric CP patients and does not cause any major complications. Based on these findings, we think PEG is a beneficial and cost-effective intervention with a high rate of tolerability in pediatric CP patients with malnutrition.
全球先天性脑瘫(CP)的患病率在0.15%至0.4%之间。CP会引发多种胃肠道并发症,影响正常进食行为。这项单中心观察性研究旨在确定经皮内镜下胃造口术(PEG)在营养不良的小儿CP患者中的耐受性和益处。
该研究纳入了41例营养不良的小儿CP患者。所有患者数据均回顾性地取自土耳其伊斯坦布尔巴基尔柯伊萨迪·科努克博士研究与培训医院小儿胃肠病学、肝病学和营养科。除了对体重、身高、肱三头肌皮褶厚度、1,25-二羟维生素D3、叶酸、铁、锌、维生素B12、血红蛋白和平均红细胞体积进行基线测量外,分析的数据还包括PEG术后3个月和6个月记录的随访测量值(标准聚合物肠内补充剂,1.0千卡/毫升)。
PEG术后3个月和6个月时,所有患者的身高、体重和肱三头肌皮褶厚度均有显著改善(<0.05)。在血液参数方面,除血红蛋白计数低的患者数量在PEG术后3个月和6个月时显著减少外(=0.022),无显著改善。此外,PEG术后呕吐的患者数量在3个月和6个月时也显著减少(=0.004)。
PEG显著改善了小儿CP患者的营养不良状况,且未引起任何重大并发症。基于这些发现,我们认为PEG对于营养不良的小儿CP患者是一种有益且具有成本效益的干预措施,耐受性较高。