ABSTRACT
Background: Cerebral palsy is a common cause of childhood morbidity and mortality particularly in developing countries like Pakistan. Though it usually presents as gross motor developmental delay, however, one of its common but under reported mode of presentation is recurrent pneumonia
Objective: To determine the clinical and radiological profile of children with cerebral palsy presenting as recurrent pneumonia
Patient and Methods: This prospective descriptive study was conducted at a tertiary care centre for a period of one year, from 1[st] January to 31[st] December 2011. All the patients who presented with recurrent chest infections were evaluated for their neurodevelopmental status with the help of detailed history and meticulous examination. Only those cases of recurrent pneumonia who were also having cerebral palsy were included in the study while all neurodevelopmentally normal or those having neurodevelopmental abnormalities other than cerebral palsy were excluded from the study. In all cases of suspected cerebral palsy detailed history especially regarding developmental miles tones, complaints of respiratory system [fever, cough, dyspnea, tachypnea etc.], birth history, feeding history and family history was taken. The symptoms of overt direct aspiration i.e. coughing, chocking, gagging, apnea, becoming dyspnoeic / tachypnoeic / cyanotic during feeding or restlessness after feeding were specifically asked and feeding was also observed. Meticulous clinical examination including detailed examination of the oral cavity, respiratory, cardiovascular and central nervous system was carried out. Developmental and CNS examination was also repeated after recovery from pneumonia. In infants extensor spasm of neck and trunk muscles, demonstrated by both ventral and dorsal suspension was the most sensitive sign for the diagnosis of cerebral palsy. Investigations carried out in all patients were CBC and X-Ray chest while blood C/S, serum biochemistry, Arterial Blood Gases [ABGs], ECG, echocardiography and CT scan brain was carried out in selective cases where indicated
Results: During the study period of one year, 14805 patients were admitted in Pediatric department. Of these, 4442 [30%] were neonatal and 10363 [70%] were post-neonatal admissions. Recurrent pneumonia as a result of cerebral palsy was diagnosed in 168 patients who accounted for 1.13% and 1.62% of the total and post-neonatal admissions respectively. 108[64%] patients were below the age of one year, 45 [27%] patients from 1 to 5 years while 15 [09%] patients were having age above 5 years. Radiological findings were also variable among different age groups with involvement of both lungs in almost all the cases, main findings included the presence of generalized hyperinflation along with wide spread, particularly perihilar infiltrates and consolidation / collapse, mainly of right upper I middle lobes
Conclusion: Cerebral palsy is a common disorder leading to disability and deaths. Respiratory problems especially recurrent pneumonia is a common complication of cerebral palsy. Solid and sustainable strategies need to be developed and implemented to reduce the incidence and complications of cerebral palsy