Parâmetros nutricionais e efeito da alimentação por gastrostomia em crianças e adolescentes com tetraparesia espástica

Abstract

Spastic Quadriplegic cerebral palsy is a sort of a non-progressive chronic encephalopathy, which is related to a neurological condition linked to serious motor abnormalities, deficient food intake, body composition compromising and frequent malnourishment. Gastrostomy is being indicated to children who have difficulties in feeding due to the non-progressive chronic encephalopathy. The aim was to evaluate nutritional status of children and teenagers carriers of non-progressive chronic encephalopathy with spastic quadriplegic cerebral palsy (through comparison with specifics curves and skinfolds), dysfunctions frequency of digestive motility and the nutritional status comparison of those who feed via gastrostomy and via oral. It was also verified the accordance between growth curves used to pediatric people in general, and specifics curves for patients with non-progressive chronic encephalopathy. Sectional study which were included 54 patients. The following data were obtained: knee height, estimated stature, weight, skin folds and arm circumference. Skin folds and circumferences values were compared to Frisancho's reference values. Brooks curves at al. were used as referential standards, and were defined as malnourished those who were below the 25 th percentile to the age. Nutritional parameters' difference between the group feed via gastrostomy and via oral was measured by Chi-square test and Fisher exact test.Significance level adopted was 5%. From 54 patients, 34 were male and the average age was 10.2 years old. Twenty five patients were feed via gastrostomy and 29 via oral. It was observed that 70% (38/54) of all patients were considered as eutrophic as weight and body mass parameters for the age, while 100% (54/54) had the ideal stature for the age.Malnourishment related to triceps skinfold was observed in 30% (26/54), while 52% (28/54) presented lean mass depletion through arm circumference. Was also verified that digestive motility, such as gastroesophageal reflux, swallowing disorders and intestinal constipation were frequent in group feed via gastrostomy, and a probable factor for surgery indication. Via oral group presented more individuals in malnourishment range (24,24%, or 7/12), besides higher levels of lean mass depletion, and also of adipose mass when compared to in group feed via gastrostomy. In 14,3% of patients who were classified as eutrophic in weight/age parameters in according to referential curve, Z-Score classified them as malnourished and the same happened in 10% on their body mass index. The reference curve has classified all patients as suitable stature to their ages.x This study allowed to conclude that anthropometric parameters indicates that patients from via oral group present a higher compromising of nutritional status than patients of gastrostomy group.