Experience in catering for patients with cerebral palsy during comprehensive rehabilitation at the Federal center

Introduction. The formation of an adequate diet in children with cerebral palsy (CP) is associated with a number of difficulties, including the assessment of nutritional status and the need for nutrients and energy, the presence of dysphagia and other disorders. At the same time, dietary support for these children is critical for improving their somatic status and, consequently, their rehabilitation potential. According to the 2017 ESPGHNG recommendations, an individual approach is required to optimize dietary measures and monitor their effectiveness in CP children, including evaluating body composition indices.

The purpose of the study is to optimize the nutritional support of CP children in conditions of a comprehensive rehabilitation in the Federal center.

Materials and methods. In the study performed in the National Medical Research Center for Children’s Health, there were observed 27 CP children (G80) with concomitant protein-energy malnutrition (PEM), including 11 (40.7 per cent) of girls aged 5-11 years (average age of 7.4 (5.7; 8.0) years). The assessment of anthropometric data was carried out using the software «WHO AnthroPlus», bioimpedance analysis of the component composition of the body was carried out on the device-analyzer «ABC-01 Medass», the assessment of the chemical composition of the diet was carried out using the software “Diet”. Dietary support consisted of correcting the basic diet, prescribing specialized hypercaloric mixtures and medication therapy. Dynamic control of the nutritional status of observed patients was performed after 2 months of complex nutritional correction. 

Results. At the beginning of this study, patients were distributed according to the degree of PEM as follows: mild — in 17 (63.0%), moderate — in 5 (18.5%), severe-in 5 (18.5%); after a two-month course of drug therapy and nutritional correction — 22 (81.5%), 2 (7.4%) and 3 (11.1%), respectively. The integrated use of drug therapy and nutritional correction has resulted in 55.5% of patients with rapid improvement in nutritional status, which was manifested by an imroved appetite, weight gain, positive dynamics of anthropometric indices, normalization of the signal, including affecting performance, and thus on the rehabilitation potential of the child.

Conclusion. The obtained data indicate the possibilities of nutritional support in the complex treatment of children with cerebral palsy to be underestimated and indicate the need to include in the diagnostic and treatment algorithms of CP children consultations by a dietitian and appropriate therapeutic measures.

1. Studenikin V.M., ed. Pediatric Neurodietology [Neyrodietologiya detskogo vozrasta]. Moscow: Dinastiya; 2012. (in Russian)

2. Sullivan P.B., Juszczak E., Lambert B.R., Rose M., Ford-Adams M.E., Johnson A. Impact of feeding problems on nutritional intake and growth: Oxford feeding study II. Dev. Med. Child Neurol. 2002; 44(7): 461-7. https://doi.org/10.1017/s0012162201002365

3. Romano C., van Wynckel M., Hulst J., Broekaert I., Bronsky J., Dall’Oglio L., et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J. Pediatr. Gastroenterol. Nutr. 2017; 65(2): 242-64. https://doi.org/10.1097/MPG.0000000000001646

4. Samson-Fang L., Fung E., Stallings V.A., Conaway M., Worley G., Rosenbaum P., et al. Relationship of nutritional status to health and societal participation in children with cerebral palsy. J. Pediatr. 2002; 141(5): 637-43. https://doi.org/10.1067/mpd.2002.129888

5. Wodarski LA. An interdisciplinary nutrition assessment and intervention protocol for children with disabilities. J. Am. Diet. Assoc. 1990; 90(11): 1563-8.

6. Pak L.A., Makarova S.G., Chumbadze T.R., Fisenko A.P. Disorders of nutritional status and their correction in children with cerebral palsy. Rossiyskiy pediatricheskiy zhurnal. 2019; 22(1): 23-7. https://doi.org/10.18821/1560-9561-2019-22-1-23-27 (in Russian)

7. Pyr’eva E.A., Sorvacheva T.N., Maksimycheva T.Yu., Ayvazyan S.O. Dietary Approaches in the Complex Treatment of Children with Neurological Pathology: a Training Manual [Dietologicheskie podkhody v kompleksnom lechenii detey s nevrologicheskoy patologiey: uchebnoe posobie]. Moscow; 2017. (in Russian)

8. WHO Anthro Plus for Personal Computers Manual: Software for assessing growth of the world’s children and adolescents. Geneva; 2009. Available at: http://www.who.int/growthref/tools/en/

9. Rudnev S.G., Soboleva N.P., Sterlikov S.A., Nikolaev D.V., Starunova O.A., Chernykh S.P., et al. Bioimpedance Study of the Body Composition of the Population of Russia [Bioimpedansnoe issledovanie sostava tela naseleniya Rossii]. Moscow; 2014. (in Russian)

10. Scarpato E., Staiano A., Molteni M., Terrone G., Mazzocchi A., Agostoni C. Nutritional assessment and intervention in children with cerebral palsy: a practical approach. Int. J. Food Sci. Nutr. 2017; 68(6): 763-70. https://doi.org/10.1080/09637486.2017.1289502

11. Bandini L.G., Schoeller D.A., Fukagawa N.K., Wykes L.J., Dietz W.H. Body composition and energy expenditure in adolescents with cerebral palsy or myelodysplasia. Pediatr. Res. 1991; 29(1): 70-7. https://doi.org/10.1203/00006450-199101000-00014

12. Andrew M.J., Parr J.R., Montague-Johnson C., Braddick O., Laler K., Williams N., et al. Optimising nutrition to improve growth and reduce neurodisabilities in neonates at risk of neurological impairment, and children with suspected or confirmed cerebral palsy. BMC Pediatr. 2015; 15: 22. https://doi.org/10.1186/s12887-015-0339-2

13. Calis E.A., Veugelers R., Rieken R., Tibboel D., Evenhuis H.M., Penning C. Energy intake does not correlate with nutritional state in children with severe generalized cerebral palsy and intellectual disability. Clin. Nutr. 2010; 29(5): 617-21. https://doi.org/10.1016/j.clnu.2010.02.006

14. Marchand V., Motil K.J. Nutrition support for neurologically impaired children: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J. Pediatr. Gastroenterol. Nutr. 2006; 43(1): 123-35. https://doi.org/10.1097/01.mpg.0000228124.93841.ea