Sanem YILMAZ, Sarenur GÖKBEN, Hasan TEKGÜL, Hande TEKİN, Dilek ARSLANGİRAY, Hediye REYHAN, Gül SERDAROĞLU

Prevalence and severity of malnutrition in pediatric neurology outpatients with respect to underlying diagnosis and comorbid nutrition and feeding related problems

This study aimed to determine prevalence and severity of malnutrition withrespect to underlying diagnosis and co-morbid nutrition and feeding relatedproblems in pediatric neurology outpatients. A total of 1,057 pediatricneurology outpatients (7.2±5.4 years, 56.9% males) were included. Data onpatient demographics, neurological diagnosis, anthropometrics and NutritionalQuestionnaire (NQ) for co-morbid feeding difficulties and nutritional problemswere recorded. Epilepsy (45.2%) was the most common diagnosis, whileprevalence of acute malnutrition was 17.7%. Nutritional support resultedin a significant decrease in the percentage of malnourished patients (from17.1% to 6.7%, p˂0.001) and significant improvement in weight for heightscores (increased to 81.42±8.17, p=0.045). In NQ-10 item assessment, atleast one item was positive in 66.0% (gastrointestinal in 54.3%) of acutelymalnourished patients, more commonly in severe acute malnutrition. NQ 4-item set of “red flags” revealed that prolonged meal time, meal time stressfulto child or parent, lack of weight gain not just weight loss and cough duringfeeding were evident in 45.2%, 46.8%, 36.7% and 14.8% of patients withacute malnutrition, respectively; and more common in patients with severemalnutrition. NQ 4-item set of “red flags” was associated with high sensitivity(95%) and specificity (88%) in detection of malnutrition. In conclusion, ourfindings in a cohort of pediatric neurology outpatients revealed that 17.1%of overall patients were acutely malnourished along with higher prevalence ofmalnutrition in underlying diagnosis of cerebral palsy and higher likelihoodof nutritional problems and feeding difficulties in severe malnutrition. Giventhe association of 6-month nutritional support with improved anthropometricsand decreased percentage of malnourished patients, our findings indicate thatincreased awareness of nutritional status and nutritional support is essentialfor the care of neurologically impaired children with potential benefit ofidentifying early feeding/swallowing related signs of malnutrition.

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Kerac M, Postels DG, Mallewa M, et al. The interaction of malnutrition and neurologic disability in Africa. Semin Pediatr Neurol 2014; 21: 42-49.
Quitadamo P, Thapar N, Staiano A, Borrelli O. Gastrointestinal and nutritional problems in neurologically impaired children. Eur J Paediatr Neurol 2016; 20: 810-815.
Brooks J, Day S, Shavelle R, Strauss D. Low weight, morbidity, and mortality in children with cerebral palsy: New clinical growth charts. Pediatrics 2011; 128: e299-e307.
Kuperminc M, Stevenson RD. Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev 2008; 14: 137-146.
Schwartz SM, Corredor J, Fisher-Medina J, Cohen J, Rabinowitz S. Diagnosis and treatment of feeding disorders in children with developmental disabilities. Pediatrics 2001; 108: 671-676.
World Health Organization (WHO). WHO child growth standards and the identification of severe acute malnutrition in infants and children: A Joint Statement by the World Health Organization and the United Nations Children’s Fund 2009. Available at: http://www. who.int/nutrition/publications/severemalnutrition/ 9789241598163_eng.pdf (Accessed on Feb 2017)
Wong SS, Derry F, Sherrington K, Gonzales G. An audit to evaluate the use of nutrition screening tool in the National Spinal Injury Centre, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust. Proc Nutr Soc 2009; 68 (OCE 1): E53.
Moore GE, Lindenmayer AW, McConchie GA, Ryan MM, Davidson ZE. Describing nutrition in spinal muscular atrophy: A systematic review. Neuromuscul Disord 2016; 26: 395-404.
Wong S, Graham A, Hirani SP, Grimble G, Forbes A. Validation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) in patients with spinal cord injuries (SCIs). Spinal Cord 2013; 51: 424-429.
Wong S, Graham A, Harini SP, Grimble G, Forbes A. Profile and prevalence of malnutrition in children with spinal cord injuries-assessment of the Screening Tool for Assessment of Malnutrition in Paediatrics (STAMP). Spinal Cord 2012; 50: 67-71.
Sullivan PB, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P. Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study. Dev Med Child Neurol 2000; 42: 674-680.
Patrick J, Boland M, Stoski D, Murray GE. Rapid correction of wasting in children with cerebral palsy. Dev Med Child Neurol 1986; 28: 734-739.
Sanders KD, Cox K, Cannon R, et al. Growth response to enteral feeding by children with cerebral palsy. JPEN J Parenter Enteral Nutr 1990; 14: 23-26.
Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr 2013; 67 (Suppl 2): S9-S12.
Behesti M, Imanzadeh F, Shahidi N. Evaluation of the nutritional status in children admitted to the neurology ward of Mofid Children’s Hospital. Iran J Child Neurology 2010; 3: 51-57.
Herrera-Anaya E, Angarita-Fonseca A, HerreraGalindo VM, Martínez-Marín RD, Rodríguez-Bayona CN. Association between gross motor function and nutritional status in children with cerebral palsy: A cross-sectional study from Colombia. Dev Med Child Neurol 2016; 58: 936-941.
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39: 214-223.
Jauhari P, Bhargava R, Bhave A, Kumar C, Kumar R. Comorbidities associated with intellectual disability among pediatric outpatients seen at a teaching hospital in Northern India. J Policy Pract Intellect Disabil 2012; 9: 10-16.
Sullivan PB. Gastrointestinal disorders in children with neurodevelopmental disabilities. Dev Disabil Res Rev 2008; 14: 128-136.
Johnson CB, Deitz JC. Time use of mothers with preschool children: A pilot study. Am J Occup Ther 1985; 39: 578-583.
Gisel EG, Patrick J. Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet 1988; 1: 283-286.
Reilly S. Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study. Dev Med Child Neurol 2001; 43: 358.
Soylu OB, Unalp A, Uran N, et al. Effect of nutritional support in children with spastic quadriplegia. Pediatr Neurol 2008; 39: 330-334.
Crepin S, Godet B, Chassain B, Preux PM, Desport JC. Malnutrition and epilepsy: A two-way relationship. Clin Nutr 2009; 28: 219-225.
Garg BP. Dysphagia in children: An overview. Semin Pediatr Neurol 2003; 10: 252-25