ABSTRACT
Undernutrition is a frequent problem in children with cerebral palsy who often have significant impairment of the eating and swallowing mechanism. A prevalence of oropharyngeal dysfunction and gastroesophageal reflux [GER] in 30 preschool children with cerebral palsy [CP] was studied using videofluoroscopy with barium contrast. The relation of their feeding dysfunction to their nutritional status was evaluated. Seventeen of these children had spastic tetraplegia, 10 had cerebral diplegia and only 3 had hemiplegia. Five children [16.7%] of our sample had no feeding dysfunction, they all had mild functional motor impairment and topographically, they had diplegia; 83.3% of these children had feeding dysfunction. Of these, 44% had combined dysfunction, 28% had isolated swallowing defect and 28% had isolated GER. Evidence of respiratory infection was present in 7 patients during radiological examination. Malnutrition, defined as triceps skin fold thickness [TSF] less than the third percentile for age and sex, was present in 50% of the cases. We found negative correlation between the degree of severity of cerebral palsy and both TSF and weight standard deviation score [r: -0.867, r: -0.748respectively]. Children with combined swallowing defect and GER had the lowest mean TSF and weight standard deviation score [3.26 +/- 0.52 mm and -3.4 +/- 0.87 respectively]. These findings were statistically significant [F= 2.83 and 3.12 respectively]. This study showed the value of using videofluoroscopy for assessment of feeding dysfunction in children with cerebral palsy. Assessment of secondary malnutrition and feeding dysfunction should be regarded as an important part of their general care. A multidisciplinary team should carry out this assessment
Subject(s)
Humans , Male , Female , Deglutition Disorders , Gastroesophageal Reflux , Nutritional Status , Child , Feeding and Eating Disorders of Childhood , InhalationABSTRACT
Developmental dysplasia of the hip [DDH] continues to be missed by routine physical screening examinations in the early months when treatment is most effective. Real time ultrasonography is valuable in detection of DDH in the young infants less than three months old. We performed a prospective study to evaluate the use of ultrasound screening that targets a select [high risk newborn] population for DDH aiming to increase the early diagnosis of this condition and decrease the incidence of late cases. From 2121 live births in our hospitals; we identified 188 [8.8%] newborns with risk factors for DDH. We followed these patients by clinical examination and ultrasound at birth, 6 weeks and 12 weeks of age. Initial ultrasound scan showed that 28% of the cases had findings suggestive of dysplastic hip, about half of them were clinically normal during neonatal examination. On subsequent scanning, the proportion of abnormal hip decreased gradually so that by 12 weeks, 80% had normal ultrasound appearance. Abnormality was more common in babies with breech presentation and family history of DDH. One female infant, not diagnosed by clinical examination at birth and with no risk factors, had abnormal clinical examination and ultrasound appearance of DDH by 12 weeks. From our study, we conclude that selective screening with ultrasound for the hip of newborns with specific physical and historical risk factors for DDH is more effective than clinical screening alone. It targets treatment to these infants who need it, and reveals a number of dislocated and subluxated hips that would otherwise be missed. It is better done when they are 4-6 weeks old. Clinical assessment cannot be restricted only to the first 2-3 days after birth but continued during the first year of life