Prevalence, trends, and correlates of malnutrition among hospitalized children with cerebral palsy

Abstract

Aim This cross‐sectional study characterized the prevalence, trends, sociodemographic factors, and clinical factors that are associated with a coded diagnosis of malnutrition (CDM) among hospitalized children with cerebral palsy (CP) in the USA. Method We used data from the 2002 to 2015 National Inpatient Sample database and restricted the analysis to hospitalized children with CP between 2 and 17 years of age. International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis codes for CP, malnutrition, and comorbidities associated with CP were used to characterize hospitalizations for this population. Logistic regression models were conducted to identify the sociodemographic factors and comorbidities associated with a diagnosis of malnutrition. Results The average documented rate of CDM among hospitalized children with CP was 7.9% and nearly doubled during the study period. The model suggests that younger age, non‐white ethnicity, lower income, and non‐private insurance/payer status were associated with increased odds of documented malnutrition. Concomitant inpatient diagnoses of epilepsy, dysphagia, scoliosis, reflux, and constipation were associated with higher rates of CDM. Interpretation The rate of CDM in hospitalized patients with CP is well under the estimated clinical prevalence of 30% to 40%. Multiple sociodemographic, hospital, and clinical factors are associated with higher rates of CDM. What this paper adds The documented rate of malnutrition in hospitalized children with cerebral palsy (CP) averaged 7.9% yearly. For hospitalized children with CP, documentation of malnutrition nearly doubled between 2002 and 2015. Economically disadvantaged and minority ethnic groups had a greater likelihood of malnutrition documentation. Inpatient malnutrition documentation was more likely with some comorbidities indicative of greater impairments. Gastrointestinal disorders increased the likelihood of an inpatient‐documented diagnosis of malnutrition.

Multi-Organ Dysfunction in Cerebral Palsy

“…Children with more severe CP are at greater risk of poor nutritional status ( 218 ). It is estimated that up to 46% of children with CP can be classified as undernourished ( 219 ), however, it is only documented in 7.9% of children with CP admitted to hospital, suggesting significant under recognition ( 220 ). Dysphagia, GORD and constipation were significantly associated with malnourishment ( 220 ).…”

“…It is estimated that up to 46% of children with CP can be classified as undernourished ( 219 ), however, it is only documented in 7.9% of children with CP admitted to hospital, suggesting significant under recognition ( 220 ). Dysphagia, GORD and constipation were significantly associated with malnourishment ( 220 ). ESPGHAN has published detailed recommendations for monitoring and managing nutritional status in children with NI, including biannual monitoring of anthropometric measurements and annual measurement of micronutrients.…”

Recognizing and documenting undernutrition in hospitalized children with cerebral palsy

“…However, Reyes et al . show that coding doubled during the last few years in hospitalized children with CP in the US which is a sign that recognition of undernutrition in this population is improving.…”

“…Nutritional evaluation and management should be performed by a multidisciplinary team, ideally including, a physician, dietitian, nurse, speech therapist, physical therapist, psychologist, and occupational therapist, as required. 2 However, Reyes et al 1 show that coding doubled during the last few years in hospitalized children with CP in the US which is a sign that recognition of undernutrition in this population is improving. REFERENCES 1.…”

“…In their paper, Reyes et al report that the prevalence of documented undernutrition in hospitalized children with cerebral palsy (CP) in the US is much lower than expected (<8%), but that it nearly doubled between 2002 and 2015. 1 Considering the negative impact of undernutrition on mortality, morbidity, and quality of life of this fragile population, this study is important.…”