Cerebral Palsy and Growth Failure at 6 to 7 Years

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Surviving infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia have decreased rates of CP in childhood. CP is associated with increased risk of slow growth. WHAT THIS STUDY ADDS:Term children with HIE who develop moderate/severe CP are at high risk of progressive impaired growth, high rates of cognitive impairment, and rehospitalizations from infancy to school age. Gastrostomy tube placement to facilitate feeds is protective of slow growth. abstract OBJECTIVE: To evaluate the association between severity of cerebral palsy (CP) and growth to 6 to 7 years of age among children with moderate to severe (Mod/Sev) hypoxic ischemic encephalopathy (HIE). It was hypothesized that children with Mod/Sev CP would have poorer growth, lower cognitive scores, and increased rehospitalization rates compared with children with no CP (No CP).METHODS: Among 115 of 122 surviving children followed in the hypothermia trial for neonatal HIE, growth parameters and neurodevelopmental status at 18 to 22 months and 6 to 7 years were available. Group comparisons (Mod/Sev CP and No CP) with unadjusted and adjusted analyses for growth ,10th percentile and z scores by using Fisher' s exact tests and regression modeling were conducted. RESULTS:Children with Mod/Sev CP had high rates of slow growth and cognitive and motor impairment and rehospitalizations at 18 to 22 months and 6 to 7 years. At 6 to 7 years of age, children with Mod/ Sev CP had increased rates of growth parameters ,10th percentile compared with those with No CP (weight, 57% vs 3%; height, 70% vs 2%; and head circumference, 82% vs 13%; P , .0001). Increasing severity of slow growth was associated with increasing age (P , .04 for weight, P , .001 for length, and P , .0001 for head circumference). Gastrostomy feeds were associated with better growth.CONCLUSIONS: Term children with HIE who develop Mod/Sev CP have high and increasing rates of growth ,10th percentile by 6 to 7 years of age. These findings support the need for close medical and nutrition management of children with HIE who develop CP. to 22 months and 6 to 7 years with growth data at birth discharge, 18 to 22 months, and 6 to 7 years. 7 Detailed demographic information and medical history were obtained at follow-up. Growth ParametersWT was obtained by using a horizontal scale at birth, discharge, and 18 to 22 months, and an upright scale at 6 to 7 years. Standard procedures were used. 7 Recumbent LT was used at birth, discharge, and 18 to 22 months and upright stature at 6 to 7 years with a permanently affixed stadiometer or upright scale. Horizontal measurement was obtained with a stadiometer for children who were unable to stand. The World Health Organization growth standards 26 were used to determine percentiles, velocities, and z scores at birth, discharge, 18 to 22 months, and at 6 to 7 years; the 2000 Centers for Disease Control and Prevention growth charts 27 were used at 6 to 7 years. Neurodevelopmental AssessmentsComprehensive assessments of neurologic statu...