Do children and adolescents with cerebral palsy from Argentina and Germany grow differently?

Abstract

Purpose: To analyze growth patterns of children with CP between countries; to examine differences in growth; and to assess the fit of growth charts. Methods: Cross-sectional study in children with CP from 2 to 19 years old, 399 from Argentina and 400 from Germany. Growth measures were converted into z-scores and compared to WHO reference and US CP growth charts. Generalized Linear Model was used to analyze the growth expressed as mean z-scores. Results: 799 children. Mean age 9 years (± 4). Compared to the WHO reference, the decrease in Height z-scores (HAZ) with age in Argentina (-0.144/year) was double that in Germany (−0.073/year). For children in GMFCS IV-V, BMI z-scores (BMIz) decreased with age (−0.102/year).Using the US CP charts, both countries showed decreasing HAZ with age, in Argentina (−0.066/year) and in Germany (−0.032/year). BMIZ increased more among children with feeding tubes (0.062/year), similar in both countries. Argentinian children with oral feeding decrease their Weight z-score (WAZ) by −0.553 compared to their peers.With WHO charts BMIZ presented an excellent fit for GMFCS I-III. HAZ presents a poor fit to growth references. BMIZ and WAZ presented a good fit to US CP Charts.Conclusions: Growth differences due to ethnicity also act in children with CP, and are related to motor impairment, age and feeding modality, possibly reflecting differences in environment or health care.