Comparative study on gastrostomy and orally nutrition of children and adolescents with tetraparesis cerebral palsy

Abstract

-Background -Gastrostomy tube feeding (GTF) is indicated for children with feeding difficulties due to tetraspastic cerebral palsy, although there are no definitive conclusions about the benefits of GTF. Objective -To compare nutritional status and diet of pediatric patients with tetraparesis cerebral palsy who are fed by GTF with those fed orally (PO). Methods -A transversal and descriptive study on 54 patients with spastic tetraparesis was held. The referred parameters were: weight, knee height and estimated height, cutaneous folds and circumferences. The Frisancho reference was used to compare the skin folds and body circumferences. The Brooks et al. curve was adopted as a reference for weight, height, and BMI. Food inquiry was performed using the Habitual Dietary Recall method. The total energetic value (TEV) of macronutrients and fibers was performed by Avanutri ® version 4.0, a nutrition software program. The differences of nutritional parameters between the GTF and the PO groups were calculated by chi-squared and Fisher's exact tests, and the comparison between the groups for variable numbers was performed using the Mann-Whitney test. The significance level adopted was 5%. Results -The PO group presented more individuals in the malnourished range (24.14%) and high levels of adipose and thin mass depletion. The ingestion of lipids was larger in the GTF group, even though the proteins and fibers were higher in the PO group. The comparison between the diets in the GTF group indicated that the mixed diet (industrialized and artisanal) supplied a greater contribution of proteins and fibers. Conclusion -Comparing the groups, the tetraparesis cerebral palsy patients fed orally have a greater impairment of their nutritional status, even though they have higher intakes of protein and fiber than those patients fed by gastrostomy, demonstrating a consistent argument for the use of gastrostomy.

Quality of Life in Caregivers of Pediatric Patients With Cerebral Palsy and Gastrostomy Tube Feeding

“…TCP patients were taken care by their mothers and grandmothers. Median age of TCP patients was seven years old (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

“…Patients with major impairment -Gross Motor Function Classification System (GMFSC) level V (3,4) -require more intensive care as these individuals are totally dependent. Some of them may require the use of Gastrostomy Tube Feeding (GTF) that is usually indicated for children who have feeding difficulties, failure to thrive and dysphagia (5) . Besides notable benefits with the use of GTF (6) , both conditions require great care and can represent a challenge to the quality of life of patients and caregivers.…”

Non-Surgical Nutritional Interventions in Children with Cerebral Palsy – Developing a Targeted Interdisciplinary Approach in a Low-Cost Setting

“…The initial search resulted in thirty-two articles. Sixteen articles [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] were selected which focused exclusively on patients with cerebral palsy and their nutrition after the removal of any duplicated articles. Of this number, only four articles described protocols in their entirety which could be directly applicable [1,6,10,11].…”

Suboptimal Nutrition and Low Physical Activity Are Observed Together with Reduced Plasma Brain-Derived Neurotrophic Factor (BDNF) Concentration in Children with Severe Cerebral Palsy (CP)

“…In a study by Sullivan et al 2005, feeding by gastrostomy in children with CP resulted in increased energy intake and body weight [71]. That tube feeding is superior to oral feeding in terms of increasing body weight is supported by comparative studies on children with CP, reporting a higher incidence of children with CP who were low in age-related weight when orally fed compared to gastronomy tube fed [72,73]. However, the orally fed children, in one of these studies, had a higher intake of dietary fibers than the gastronomy tube children [72].…”