European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment

Abstract

Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.

Anthropometric measurements to identify undernutrition in children with cerebral palsy

“…Many authors reported that children with CP were prone to stunted growth, independent of their nutritional status. 19,21 Further research is needed to determine the most reliable and applicable tools to recognize undernutrition in children with CP. Therefore, we suggest using stunted growth as an indicator for undernutrition in children with CP with caution.…”

“…16 Unfortunately, there is no widely accepted consensus as to which cut-off for the BMI z-score should be used to identify undernutrition (e.g. 19 They stated that 'the assessment of nutritional status in children with neurological impairment should not be based solely on weight and height' and recommended that the measurement of fat mass should be a routine component of the nutritional assessment. 17,18 Recently, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition reported guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment, where CP was considered as a proxy.…”

Epicardial Fat Thickness in Non-Obese Neurologically Impaired Children: Association with Unfavorable Cardiometabolic Risk Profile

“…However in the pediatric age, contradictory findings on different anthropometric measures and cardiometabolic risk association have been reported. European Society for Pediatric Gastroenterolgy Hepatology and Nutrition (ESPGHAN) Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children with Neurological Impairment [26] recommend using skinfold thickness rather than BMI for nutritional assessment in NI children, which provides better estimates of body fat. The guidelines also underscore that their interpretation is very challenging because children with NI tend to store fat more centrally (abdomen) than peripherally.…”

Consistency in Assessing Physical Development of Children With Cerebral Palsy According to Regional and Specialized Centile Scales: A Population-Based Cross-Sectional Stud

“…Известно, например, что у детей с GMFCS III-V уровня и массой тела < 20-го перцен-тиля риск смерти в 1,5 раза выше, чем у детей с нормальны-ми показателями физического развития [28]. В этой связи можно предположить, что при наличии таких антропоме-трических показателей у ребенка с ДЦП необходимо про-ведение нутритивных вмешательств (назначение высоко-калорийных смесей, зондовое питание, установка стом) [29].…”

“…Кроме того, преимуществом специализированных центильных шкал является возмож-ность выявления ребенка с церебральным параличом, имеющим недостаточность питания, и выполнение реко-мендаций Европейского общества детских гастроэнтеро-логов, гепатологов и нутрициологов (European Society for Paediatric Gastroenterology and Hepatology and Nutrition, ESPGHAN) по диагностике и лечению детей, имеющих гастроинтестинальные и нутритивные осложнения при неврологической патологии. Так, согласно рекомендаци-ям [29], врачу-педиатру при выявлении БЭН, высокого риска аспирации, аспирационной пневмонии в анамнезе, подозрении на дисфагию необходимо направить ребенка на консультацию к врачу-оториноларингологу для решения вопроса о флуороскопии и постановке гастростомы.…”