Respiratory morbidity in children with cerebral palsy: an overview

Boel, Lieve; Pernet, Kurt; Toussaint, Michel; Ides, Kris; Leemans, Glenn; Haan, Jurn; Hoorenbeeck, Kim Van; Verhulst, Stijn

doi:10.1111/dmcn.14060

Cited by 93 publications

(134 citation statements)

References 58 publications

(194 reference statements)

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“…In CP, the presence of epilepsy, measures of functional disability (increased severity of motor and cognitive impairment), and the need for a gastrostomy‐tube (G‐tube) feeding are the main determinants of mortality . Respiratory diseases are the most frequent cause of mortality in patients with CP, similar to IS patients …”

Section: Introductionmentioning

confidence: 99%

Mortality in infantile spasms: A hospital‐based study

et al. 2020

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Objective:To determine risk factors and causes for mortality during childhood in patients with infantile spasms (IS). We describe the overall goals of care for those who died. Methods: This is a retrospective chart review of IS patients born between 2000 and 2011. We examined potential risk factors for mortality, including etiology, neurologic impairment, medication use, persistence of epileptic spasms, and comorbid systemic involvement (requirement for G-tube feedings, respiratory interventions). For patients who died, we describe cause of death and resuscitation status or end-of-life care measures. Results: We identified 150 IS patients with median follow-up of 12 years. During the study period, 25 (17%) patients died, 13 before 5 years of age. Univariate analysis demonstrated that developmental delay, identifiable etiology, hormonal use for IS, persistence of epileptic spasms, polypharmacy with antiseizure medications, refractory epilepsy, respiratory system comorbidity, and the need for a G-tube were significant risk factors for mortality. In a multivariate analysis, mortality was predicted by persistence of epileptic spasms (odds ratio [OR] = 4.30, 95% confidence interval [CI] = 1.11-16.67, P = .035) and significant respiratory system comorbidity (OR = 12.75, 95% CI = 2.88-56.32, P = .001). Mortality was epilepsy-related in one-third of patients who died with sudden unexpected death in epilepsy (SUDEP), accounting for 88% of epilepsy-related deaths. Most deaths before age 5 years were related to respiratory failure, and SUDEP was less common (17%) whereas SUDEP was more common (45%) with deaths after 5 years. For the majority (67%) of patients with early mortality, an end-of-life care plan was in place (based on documentation of resuscitation status, comfort measures, or decision not to escalate medical care). Significance: Mortality at our single-center IS cohort was 17%, and persistence of epileptic spasms and comorbid respiratory system disorders were the most important determinants of mortality. Early deaths were related to neurological impairments/ comorbidities. SUDEP was more common in children who died after 5 years of age than in those who died younger than 5 years.

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Section: Introductionmentioning

confidence: 99%

Mortality in infantile spasms: A hospital‐based study

et al. 2020

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“…Furthermore, the impaired ability to coordinate swallowing with ventilation predisposes sufferers to food aspiration. Recurrent aspiration pneumonia episodes lead to progressive lung parenchymal damage [6], worsened by compromised airway defense mechanisms, and may cause death by reflux aspiration.…”

Section: Introductionmentioning

confidence: 99%

Gastrostomy Placement and Management in Children: A Single-Center Experience

et al. 2019

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BACKGROUND: To prevent malnutrition and food aspiration in children with chronic neuromuscular problems, enteral nutrition provided by gastrostomy is recommended. Long-term follow-up data about surgical and medical complications of PEG are available, but few papers have addressed all of the issues in the same series. METHODS: This retrospective study enrolled patients under 18 years who had a gastrostomy tube placed at our institution between 2003 and 2017. The aim is to evaluate outcomes after gastrostomy placement, focusing both on surgical complications (early and late), and its effect on their nutritional status, on the prevention of pulmonary infections, and their parents’ opinion. RESULTS: Eighty-four gastrostomies were placed in total (35 F; 49 M). Seventy-seven patients had a severe neurocognitive impairment (GMFCS 5). The principal indication for gastrostomy was severe dysphagia (53.3%). No gastrostomy-related death was observed. Early surgical complications were observed in five of 84 (5,9%) patients; late complications were observed in 15 of 84 (17.8%) patients. Twenty-two patients were diagnosed with subsequent gastroesophageal reflux; five patients developed dumping syndrome (6%). Complete medical follow-up data were available for 45 patients. A progressive improvement of nutritional status was observed in 29 patients, and 11 maintained the same percentile; the occurrence of respiratory infections and need for hospitalization decreased. In 90% of cases, parents were fully satisfied with the g-tube. CONCLUSION: This study confirms the positive nutritional outcomes of gastrostomy-tube with an associated small risk of surgical complications and a reduction in the number of respiratory infections, with most parents scoring their experience as positive.

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“…Current evidence regarding management of children with CP who are at risk of developing respiratory disease is very limited [12].The purpose of this study was to systematically review the quality of evidence regarding the effectiveness of respiratory therapy on pulmonary functions in children with CP.…”

Section: Introductionmentioning

confidence: 99%

Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: a systematic review

2020

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Background Children with cerebral palsy (CP) are at risk for respiratory dysfunction. Early initiation of pulmonary rehabilitation in addition to conventional physical therapy may result in improvement and maintenance of chest mobility and respiratory function. However, empirical support for respiratory therapy is limited. The aim of the review was to assess the evidence of the effectiveness of respiratory therapy on pulmonary functions in children with CP. Methods Four electronic databases (PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), and Google Scholar) were searched till December 2019 using predefined terms by two independent reviewers. Randomized controlled trials published in English were included if they met the following criteria: population—children with different types of CP of both sex, aged up to 18 years; intervention—respiratory therapy; outcomes—pulmonary functions. Eight studies with 235 participants only met the inclusion criteria and were included in this review. Predefined data were tabulated using American Academy for Cerebral Palsy and Developmental Medicine by two reviewers and verified by a third reviewer. Methodological quality was assessed using rating system of quality assessment and PEDro scale; also, levels of evidence adopted from modified Sacket’s scale were used for each outcome. Results The quality of studies ranged from excellent (one study) to good (five studies) and fair (two studies). The results showed level 1 (six studies) and level 2 (two studies) on modified Sacket’s scale for level of evidence. Lack of allocation concealment and blinding was the major risk of bias in the included studies. Conclusions Meta-analysis revealed significant difference in the improvement of vital capacity, peak expiratory flow, and forced expiratory volume at 1 s in favor of the study groups. However, there is a need for high-quality studies to draw a clear conclusion.

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Respiratory morbidity in children with cerebral palsy: an overview

Cited by 93 publications

References 58 publications

Mortality in infantile spasms: A hospital‐based study

Mortality in infantile spasms: A hospital‐based study

Gastrostomy Placement and Management in Children: A Single-Center Experience

Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: a systematic review

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