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Gastrostomy feeding in cerebral palsy: enough and no more
Author(s) -
VERROBERTS ANGHARAD,
WELLS JONATHAN,
GRANT HUGH,
ALDER NICOLA,
VADAMALAYAN BABU,
ELTUMI MUFTAH,
SULLIVAN PETER B
Publication year - 2010
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/j.1469-8749.2010.03789.x
Subject(s) - cerebral palsy , medicine , gastrostomy , physical medicine and rehabilitation , pediatrics , psychology , surgery
Aim Gastrostomy feeding children with spastic quadriplegic cerebral palsy (SQCP) improves weight gain but may cause excess deposition of body fat. This study was designed to investigate whether weight gain could be achieved without an adverse effect on body composition by using a low‐energy feed in gastrostomy‐fed children with SQCP. Method Fourteen children (seven male; seven female; median age 2y; range 10mo–11y) with SQCP were studied, 13 of whom were classified as Gross Motor Function Classification Score (GMFCS) level V and one as GMFCS level IV. Children were eligible for the study if they weighed between 8 and 30kg with a diagnosis of severe SQCP and significant feeding difficulties in whom a clinical decision had been made to insert a gastrostomy feeding tube. The feed used in the study had an energy concentration of 0.75kcal/mL (Nutrini Low Energy Multi Fibre). Assessments were performed before gastrostomy insertion (baseline) and after 6 months, and included body composition, growth, nutritional intake, and gastrointestinal symptoms. Results There was a significant increase in weight (median difference 1.9kg; 95% confidence interval [CI] 0.85–3.03kg; p =0.012), mid‐upper arm circumference (median difference 1.45cm; 95% CI −0.36cm to 3.47cm; p =0.043), and lower leg length (median difference 1.62cm; 95% CI 0.44–3.95cm; p =0.012) over the 6 months. There was no significant increase in fat mass index (median diff 1.21, 95% CI −1.15 to 2.94, p =0.345) or fat free mass index (median diff −1.43, 95% CI −1.15 to 2.94, p =0.249). Micronutrient levels remained within reference ranges with the exception of elevated chromium. The median percentage intake of the estimated average requirements for energy (kcal) was 43% at the beginning of the study and 48.8% after 6 months on the low‐energy feed. Interpretation Children with SQCP who are fed a low‐energy, micronutrient‐complete, high‐fibre feed continue to grow even with energy intakes below 75% of the estimated average requirements. This was not associated with a disproportionate rise in fat mass or fat percentage, and the majority of micronutrient levels remained within the reference range.