Effects of gastrostomy feeding in children with cerebral palsy: an AACPDM evidence report*

The assessment of stature in children with cerebral palsy is difficult. This study tested the clinical utility of the segmental measures of upper-arm length, tibial length, and knee height as proxies for stature in children with cerebral palsy. The study included 211 sets of measurements made in 172 children with cerebral palsy attending an outpatient clinic at a pediatric rehabilitation center during a 2-year period. Forty-three percent were female, 20% black, 31% diplegic or hemiplegic, and 52% nonambulatory. An observer measured weight, head circumference, recumbent length or standing height, upper-arm length, tibial length, knee height, midarm circumference, triceps skinfold, and subscapular skinfold. The correlation coefficients were as follows: upper-arm length and stature, .97 (95% confidence interval, .95 to .98) (R2 = .94); tibial length and stature, .97 (95% confidence interval, .96 to .98) (R2 = .94); and knee height and stature, .98 (95% confidence interval, .98 to .99) (R2 = .97). The linear regression equations were used to develop formulas for the estimation of stature from a segmental measure. Upper-arm length, tibial length, and knee height are all reliable and valid proxies for stature in children with cerebral palsy up to 12 years of age. We recommend that either knee height or tibial length be measured in the routine anthropometry of children with cerebral palsy who cannot be measured by standard techniques. Estimates of stature can then be calculated and plotted on standard growth charts.

This study was done to determine survival rates in subpopulations of severely neurologically disabled children who reside in pediatric skilled nursing facilities and to compare these survival rates with those in previously published studies. Data were collected at three pediatric skilled nursing facilities over the 1986 to 1996 decade. The total study population numbered 447. We studied in detail six groups of the most severely disabled children and correlated their survival rates with clinical parameters and the presence of other significant diseases. The survival rates in our six groups of severely disabled children were significantly better than those previously reported. In group 1, our 8-year survival rate was 66%, as compared with 5% in the previous study. In group 2, our 8-year survival rate was 89%, versus 22% in the previous study. We obtained better survival rates in all six groups studied, irrespective of the analysis including children less than 1 year old, between 1 year and 15 years old, or more than 15 years old. The most significant determinant for reduced survival was the presence of other significant diseases. Those with other significant diseases had a 10-year survival rate of 45%, whereas those who were relatively healthy had a survival rate of 90%. Patients who received gastrostomy tube feedings had a better 10-year survival rate than those fed by nasogastric tube (78% vs 41%). This difference was independent of the presence of other significant medical diseases. Our results show substantially better survival rates than those previously reported. These improved results are most likely related to much more intense medical management of severely disabled children in skilled nursing facilities than at home or in other residential settings. Our study also showed a significantly better survival rate for those fed by gastrostomy tube as compared with nasogastric tube.