neurojourНеврологический журнал имени Л.О. БадалянаL.O. Badalyan Neurological Journal2686-89972712-794XФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/2686-8997-2020-1-2-122-131neurojour-24Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSОсобенности оценки нутритивного статуса и расчета потребности в нутриентах у детей с детским церебральным параличомASSESSMENT OF FEATURES OF THE NUTRITIONAL STATUS AND NUTRIENT REQUIREMENTS IN CHILDREN WITH CEREBRAL PALSYhttps://orcid.org/0000-0002-3056-403XМакароваСветлана ГеннадиевнаMakarovaSvetlana G.

Доктор мед. наук, зав. отделом профилактической медицины ФГАУ «НМИЦ здоровья детей» Минздрава России; проф. каф. факультетской педиатрии педиатрического факультета ФГАОУ ВО РНИМУ им. Н.И. Пирогова МЗ РФ; проф. каф. многопрофильной клинической подготовки факультета фундаментальной медицины ФГБОУ ВО МГУ им. М.В. Ломоносова, 119991, Москва.

e-mail: sm27@yandex.ru

MD, Ph.D., DSci., head, Department of preventive medicine of the National Medical Research Center for Children’s Health, Moscow, 119991, Russian Federation; professor of the Department of faculty pediatrics of the Pediatric faculty of the N.I. Pirogov Russian National Research Medical University, Moscow, 117997, Russian Federation; professor of the Department of multidisciplinary clinical training of the Faculty of fundamental medicine of the Lomonosov Moscow State University, Moscow, 119991, Russian Federation.

e-mail: sm27@yandex.ru

sm27@yandex.ruПакЛ. А.PakLale A.noemail@neicon.ruФисенкоА. П.FisenkoAndrey P.noemail@neicon.ruКузенковаЛ. М.KuzenkovaLyudmila M.noemail@neicon.ruhttps://orcid.org/0000-0003-3306-6869ПронинаИ. Ю.ProninaIrina Yu.noemail@neicon.ruФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России; ФГАОУ ВО РНИМУ им. Н.И. Пирогова МЗ РФ; ФГБОУ ВО «Московский государственный университет имени М.В. Ломоносова»РоссияNational Medical Research Center for Children’s Health; N.I. Pirogov Russian National Research Medical University; Lomonosov Moscow State UniversityRussian FederationФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава РоссииРоссияNational Medical Research Center for Children’s HealthRussian FederationФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России; Клинический институт детского здоровья имени Н.Ф. Филатова ФГАОУ ВО Первый МГМУ им. И.М.Сеченова Минздрава России (Сеченовский Университет)РоссияNational Medical Research Center for Children’s Health; N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)Russian Federation20203003202112122131Copyright © Макарова С.Г., Пак Л.А., Фисенко А.П., Кузенкова Л.М., Пронина И.Ю., 20212021Макарова С.Г., Пак Л.А., Фисенко А.П., Кузенкова Л.М., Пронина И.Ю.Makarova S.G., Pak L.A., Fisenko A.P., Kuzenkova L.M., Pronina I.Y.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.neuro-journal.ru/jour/article/view/24

Потребности детей с детским церебральным параличом (ДЦП) в энергии и питательных веществах обсуждаются многими отечественными и зарубежными учеными. Состояние мышечного тонуса, дисфагия, наличие псевдобульбарного синдрома, гиперкинезия или, напротив, — отсутствие физической активности — обусловливают значительные индивидуальные особенности нутритивных потребностей. Недооценка этих потребностей в сочетании с коморбидной патологией (частые пневмонии, бронхиты и пр.), характерной для этой группы пациентов, может приводить к возникновению и быстрому прогрессированию белково-энергетической недостаточности. Помимо того, имеются сложности с интерпретацией показателей их физического развития. Для детей с ДЦП разработаны специальные шкалы для оценки физического развития и формулы для расчета индивидуальной потребности в питательных веществах и энергии. Однако недооценка нутритивных потребностей детей с ДЦП может стать причиной часто встречающейся у этих пациентов белково-энергетической недостаточности — в 29-66% случаев. В связи с этим некоторые принципы организации питания и нутритивной поддержки для детей с ДЦП пересматриваются. Организация адекватной нутритивной поддержки на основе современных клинических рекомендаций и персонализированного подхода является важнейшей составляющей комплексного лечения этой сложной категории больных. В обзоре представлено современное состояние проблемы, обсуждаются подходы с точки зрения международных и отечественных руководств, а также с позиций актуальных рекомендаций Европейского общества детских гастроэнтерологов, гепатологов и нутрициологов 2017 года.

The energy and nutrient requirements of children with cerebral palsy (CP) have always been discussed among domestic and foreign scientists. A wide range of physical characteristics such as state of muscle tone, dysphagia, pseudobulbar syndrome, hyperkinesia or the lack of physical activity determine individual features of the patients’ nutritional needs. Whereas, underestimation of these needs along with comorbid pathologies (frequent pneumonia, bronchitis, etc.), characterizing this group of patients, can easily lead to the emergence and rapid progression of protein-energy deficiency. In addition, there are also difficulties with the interpretation of indices of a patients’ physical development. In this regard, both special scales for physical development assessment and formulas for individual nutrient and energy requirements calculation have been developed for this category of patients. However, according to recent data, the use of these scales and formulas can lead to underestimation of the nutritional needs of CP children. This, in its turn, can cause protein-energy deficiency, frequently (in 29-66% of cases) found in these patients. Therefore, some principles of diet and nutritional support for CP children are being reviewed now. At the same time, the organization of adequate nutritional support based on modern clinical recommendations and a personalized approach is the key component of the comprehensive treatment of this complex patients’ category. This review contains the description of the current situation, as well as a broad discussion of different approaches based on the international, domestic guidelines and relevant recommendations of the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists - ESPGHAN, 2017).

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The authors declare that there are no conflicts of interest present.