Article

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.
CI - (c) The Authors. Journal compilation (c) Mac Keith Press 2010.

Langue : ANGLAIS