Is growth and nutritional status in children with cerebral palsy related to the severity of the brain lesion?

Abstract

Background/Objectives: This study aimed to investigate the relationship between brain lesion severity assessed on structural magnetic resonance imaging (MRI) and growth and nutritional status in preschool-aged children with cerebral palsy (CP). Design: Prospective population based cohort study. Participants and Setting: Of 103 children with CP (61 male, 56 born at term, 19 preterm and 28 very preterm), with mean (SD) age 2 years 11 month (6mo), were recruited from the community. GMFCS levels were: I=51, II=5, III=17, IV=11, V=19. Motor type was bilateral spasticity (n=55), unilateral spasticity (n=30), and 18 other motor types. MRI scans were classified using Kragheloh Mann (KM) criteria into 5 groups: brain maldevelopment (BM) (n=5), periventricular white matter lesions (PWM) (n=58), cortical and deep grey matter (CDGM) (n=23), miscellaneous (M) (n=9) or normal (n=8). Methods: Brain lesion severity was scored by a trained child neurologist using a semi-quantitative scale (possible range 0 to 40). Height (n=40) or length (n=47) were measured to the last completed millimetre directly or estimated from knee height (n=16). Weight was measured to the nearest 100 grams and body mass index (BMI) was determined. Anthropometric data were converted to Z-scores to adjust for age and sex. Results are mean (SD). Data analysis was by ANOVA and post hoc independent t-tests, Pearson's correlation coefficients and linear regression models (SPSS). Significance was set at p<0.05. Results: Children with GMFCS III-V compared to GMFCS I and II, were shorter (height Z-score: -0.14 (1.19) vs -0.85 (1.23)), lighter (weight Z-score: -0.03 (1.11) vs -1.02 (1.61)) and had lower BMI's (BMI Z-scores: 0.13 (1.23) vs -0.51 (1.64)). No difference was found in any of the anthropometric variables according to qualitative MRI classification (KM). Height and weight Z-scores were related to global MRI severity score (r=-0.51 and 0.36), summary hemispheric scores for both sides of the brain (r=-0.44 and -0.33) and summary basal ganglia and brain stem scores (r=-0.44 and -0.31) for the children with PWM injury only. BMI Z-scores were not significantly related to lesion severity scores for any group. When preterm status was taken into account, the relationship remained significant for height and weight Z-scores and global MRI severity score (β= -0.49 and -0.34), summary hemisphere scores (β= -0.41 and -0.29), and summary basal ganglia and brain stem scores (β= -0.42 and -0.30). Conclusions: Brain lesion severity in children with PWM was related to height and body weight even after preterm status was considered. Children with more severe PVM were shorter and lighter than those with less severe lesions. These results suggest the need for more accurate nutritional care in patients with more severe brain lesions in the PWM group. Further investigation into the ability of this semi-quantitative MRI scale to predict future growth and nutrition outcomes is warranted.L717464002015-02-03 <br />