Prevalence, trends, and correlates of malnutrition among hospitalized children with cerebral palsy.

AIM: This cross-sectional study characterized the prevalence, trends, sociodemographic factors, and clinical factors that are associated with a coded diagnosis of malnutrition (CDM) among hospitalized children with cerebral palsy (CP) in the USA. METHOD: We used data from the 2002 to 2015 National Inpatient Sample database and restricted the analysis to hospitalized children with CP between 2 and 17 years of age. International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis codes for CP, malnutrition, and comorbidities associated with CP were used to characterize hospitalizations for this population. Logistic regression models were conducted to identify the sociodemographic factors and comorbidities associated with a diagnosis of malnutrition. RESULTS: The average documented rate of CDM among hospitalized children with CP was 7.9% and nearly doubled during the study period. The model suggests that younger age, non-white ethnicity, lower income, and non-private insurance/payer status were associated with increased odds of documented malnutrition. Concomitant inpatient diagnoses of epilepsy, dysphagia, scoliosis, reflux, and constipation were associated with higher rates of CDM. INTERPRETATION: The rate of CDM in hospitalized patients with CP is well under the estimated clinical prevalence of 30% to 40%. Multiple sociodemographic, hospital, and clinical factors are associated with higher rates of CDM. WHAT THIS PAPER ADDS: The documented rate of malnutrition in hospitalized children with cerebral palsy (CP) averaged 7.9% yearly. For hospitalized children with CP, documentation of malnutrition nearly doubled between 2002 and 2015. Economically disadvantaged and minority ethnic groups had a greater likelihood of malnutrition documentation. Inpatient malnutrition documentation was more likely with some comorbidities indicative of greater impairments. Gastrointestinal disorders increased the likelihood of an inpatient-documented diagnosis of malnutrition.

Psychosocial and medical factors associated with intrathecal baclofen pump explants: A case series.

PURPOSE: The goal of this retrospective chart review study was to explore factors that contributed to consideration of or actual pump explantation in pediatric patients with intrathecal baclofen (ITB) pumps. METHODS: Medical records of 30 patients with ITB pumps were reviewed. Quantitative data, including demographic, clinical, psychosocial, and service utilization variables were culled from the records. Qualitative data were collected from clinic visit notes, pump-related follow-up phone calls, and any pump-related emergency room visits. RESULTS: Of those reviewed, six underwent ITB pump explantation, and two considered explantation. Factors contributing to pump explantation or consideration of explantation included the following: postoperative infection, pump malfunction, non-adherence, anxiety/behavioral factors impacting the patient's tolerance of the pump, distance to the medical provider, frequency of required pump refill appointments, lack or perceived lack of intrathecal baclofen effect, and difficulty transitioning to adult care providers. CONCLUSION: Due to the complex care regimen associated with ITB pumps and various psychosocial and logistical factors that impact treatment success, a standardized multidisciplinary pre-implantation education, screening, and assessment process should be developed. Such a process would ensure that patients/families receive appropriate education, including proactively identifying treatment barriers and potential complications, possibly minimizing dissatisfaction with treatment and the need for explantation.

Ultrasound-Guided OnabotulinumtoxinA Injections to Treat Oromandibular Dystonia in Cerebral Palsy.

Cerebral palsy (CP) is a group of non-progressive disorders of motor function in children resulting from an injury to an immature brain. In addition to abnormal limb and trunk movement, individuals with CP can experience involuntary muscle contractions of the lower facial muscle groups, causing oromandibular dystonia (OMD). Contraction of the lateral pterygoids and submandibular muscles depresses the mandible. OMD involving the lateral pterygoids can therefore lead to involuntary jaw opening posture, affecting the ability to feed and speak effectively. We present a case series of five patients with CP and OMD that received novel ultrasound-guided onabotulinumtoxinA to the lateral pterygoid muscles. Our goal was to determine if chemodenervation would improve the mouth-closing ability, thus in turn improving the ability to swallow, chew, manage secretions, and communicate. We describe this unique injection method and report a subjective improvement in eating abilities and communication, in addition to a positive upward trend in most patients' weights, with no significant adverse side effects.

Adherence to serial casting protocols for idiopathic toe walking: A quality improvement initiative.

PURPOSE: This initiative aimed to assess adherence to Scottish Rite for Children's serial casting protocol for children with idiopathic toe walking (ITW), factors related to adherence, and outcomes after education regarding the protocol. METHODS: 60 patients aged 7.1±2.7 years who completed serial casting were examined at baseline phase (n = 30) and post-education phase (n = 30). Protocols include weekly serial casting for 4 to 6 weeks to achieve 10° of ankle dorsiflexion (ADF) passive range of motion (PROM) with knees extended (KE), assessing the foot posture index (FPI-6) and single leg stance (SLS). Baseline phase evaluated adherence to protocols. Education phase evaluated factors related to adherence and education regarding serial casting findings. Post-education phase evaluated the impact of the education phase. RESULTS: Serial casting averaged 4.8±1.5 weeks (n = 60). ADF PROM was measured with 100% adherence. ADF PROM KE averaged -10.7° pre-cast and significantly improved to +6.5° post-cast (n = 60), and it significantly improved post-cast post-education (p = 0.04). FPI-6 and SLS adherence significantly improved post-cast post-education. FPI-6 total score averaged +5.3 at baseline and +5.8 post-cast (n = 35). CONCLUSION: Education of staff in serial casting protocols improved adherence and patient outcomes. Patients with ITW and ADF PROM KE -10° benefit from serial casting to improve PROM and to allow for orthotic use post-casting.