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Growth in children with cerebral palsy during five years after selective dorsal rhizotomy: a practice-based study.

Westbom L, Lundkvist Josenby A, Wagner P, Nordmark E - BMC Neurol (2010)

Bottom Line: The occurrence of thinness (BMI < -2 SD) was decreased (n.s.) and obesity (BMI > + 2 SD) increased (p < 0.05).It is unknown whether the spasticity reduction through SDR increased the weight gain velocity, or if the relative weight increase was part of the general "obesity epidemic".For some children the weight increase was highly desirable.In others, it resulted in overweight and obesity with risk of negative health effects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Sciences Lund, Lund University, Sweden. lena.westbom@med.lu.se

ABSTRACT

Background: Overweight is reported as a side effect of SDR. The aims were to study the development of weight, height and body mass index (BMI) during five years after SDR.

Methods: This prospective, longitudinal and practice-based study included all 56 children with CP spastic diplegia undergoing SDR from the start in March 1993 to April 2003 in our hospital. The preoperative Gross Motor Function Classification System (GMFCS) levels were I-II in 17, III in 15, IV-V in 24 children. Median age at SDR was 4.3 years (range 2.4-7.4 years). Weight and height/recumbent length were measured. Swedish growth charts for typically developing children generated weight, height and BMI z-scores for age and gender.

Results: The preoperative median z-scores were for height -1.92 and for body mass index (BMI) -0.22. Five years later, the median BMI z-score was increased by + 0.57 (p < 0.05). The occurrence of thinness (BMI < -2 SD) was decreased (n.s.) and obesity (BMI > + 2 SD) increased (p < 0.05). Baseline BMI and age at the start of follow-up influenced the BMI change during the five years (p < 0.001 and p < 0.05 respectively).The individual growth was highly variable, but a tendency towards increasing stunting with age was seen in severe gross motor dysfunction (GMFCS levels IV-V) and the opposite, a slight catch-up of height in children with walking ability (GMFCS levels I-III).

Conclusions: These are the first available subtype- and GMFCS-specific longitudinal growth data for children with CP spastic diplegia. Their growth potential according to these data should be regarded as a minimum, as some children were undernourished. It is unknown whether the spasticity reduction through SDR increased the weight gain velocity, or if the relative weight increase was part of the general "obesity epidemic".For some children the weight increase was highly desirable. In others, it resulted in overweight and obesity with risk of negative health effects. Weight and height should be monitored to enable early prevention of weight aberrations also causing problems with mobility, activity and participation.

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Related in: MedlinePlus

Height z-scores in GMFCS I-II. Height z-score at different age in 17 children with CP spastic diplegia, GMFCS I-II. Their mean z-score development with age is shown in black.
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Figure 4: Height z-scores in GMFCS I-II. Height z-score at different age in 17 children with CP spastic diplegia, GMFCS I-II. Their mean z-score development with age is shown in black.

Mentions: Figures 1,2,3,4,5,6,7,8 &9 show mean weight, height and BMI z-scores for all 56 children with CP diplegia in the different gross motor functional levels at different age during the follow-up, together with individual plots. The children were between 7.4 and 12.4 years of age at the latest measurement. Each child is represented with the same colour in the weight, height and BMI z-scores development lines.


Growth in children with cerebral palsy during five years after selective dorsal rhizotomy: a practice-based study.

Westbom L, Lundkvist Josenby A, Wagner P, Nordmark E - BMC Neurol (2010)

Height z-scores in GMFCS I-II. Height z-score at different age in 17 children with CP spastic diplegia, GMFCS I-II. Their mean z-score development with age is shown in black.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2913912&req=5

Figure 4: Height z-scores in GMFCS I-II. Height z-score at different age in 17 children with CP spastic diplegia, GMFCS I-II. Their mean z-score development with age is shown in black.
Mentions: Figures 1,2,3,4,5,6,7,8 &9 show mean weight, height and BMI z-scores for all 56 children with CP diplegia in the different gross motor functional levels at different age during the follow-up, together with individual plots. The children were between 7.4 and 12.4 years of age at the latest measurement. Each child is represented with the same colour in the weight, height and BMI z-scores development lines.

Bottom Line: The occurrence of thinness (BMI < -2 SD) was decreased (n.s.) and obesity (BMI > + 2 SD) increased (p < 0.05).It is unknown whether the spasticity reduction through SDR increased the weight gain velocity, or if the relative weight increase was part of the general "obesity epidemic".For some children the weight increase was highly desirable.In others, it resulted in overweight and obesity with risk of negative health effects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Sciences Lund, Lund University, Sweden. lena.westbom@med.lu.se

ABSTRACT

Background: Overweight is reported as a side effect of SDR. The aims were to study the development of weight, height and body mass index (BMI) during five years after SDR.

Methods: This prospective, longitudinal and practice-based study included all 56 children with CP spastic diplegia undergoing SDR from the start in March 1993 to April 2003 in our hospital. The preoperative Gross Motor Function Classification System (GMFCS) levels were I-II in 17, III in 15, IV-V in 24 children. Median age at SDR was 4.3 years (range 2.4-7.4 years). Weight and height/recumbent length were measured. Swedish growth charts for typically developing children generated weight, height and BMI z-scores for age and gender.

Results: The preoperative median z-scores were for height -1.92 and for body mass index (BMI) -0.22. Five years later, the median BMI z-score was increased by + 0.57 (p < 0.05). The occurrence of thinness (BMI < -2 SD) was decreased (n.s.) and obesity (BMI > + 2 SD) increased (p < 0.05). Baseline BMI and age at the start of follow-up influenced the BMI change during the five years (p < 0.001 and p < 0.05 respectively).The individual growth was highly variable, but a tendency towards increasing stunting with age was seen in severe gross motor dysfunction (GMFCS levels IV-V) and the opposite, a slight catch-up of height in children with walking ability (GMFCS levels I-III).

Conclusions: These are the first available subtype- and GMFCS-specific longitudinal growth data for children with CP spastic diplegia. Their growth potential according to these data should be regarded as a minimum, as some children were undernourished. It is unknown whether the spasticity reduction through SDR increased the weight gain velocity, or if the relative weight increase was part of the general "obesity epidemic".For some children the weight increase was highly desirable. In others, it resulted in overweight and obesity with risk of negative health effects. Weight and height should be monitored to enable early prevention of weight aberrations also causing problems with mobility, activity and participation.

Show MeSH
Related in: MedlinePlus