Research Of The Nutritional And Cellular Immune Status In Children With Cerebral Palsy

Cerebral palsy(CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems. It makes cerebral palsy a common cause of disability in children that brings heavy mental and economic burden to society, families and individuals. The total prevalence of cerebral palsy reported by recent foreign studies was of 2.11‰(live births). The total prevalence of cerebral palsy in Chinese children among 1 ~ 6 years old was 1.92‰, and the prevalence of cerebral palsy in children from Henan Province among 0 ~ 6 years old was 2.37‰.Growth retardation and malnutrition are the complications of cerebral palsy. Compared with typically developing peers, the height, weight, body fat, muscle mass and bone mineral density of children with cerebral palsy were all lower. Factors affecting the growth and development of children with cerebral palsy were mainly including the nutritional and non-nutritional factors. Nutritional factors were considered to be the main factors, feeding difficulties and swallowing disorders due to impaired central nervous system were the common cause of inadequate dietary intake in children with cerebral palsy. The severity of disease, age, low body weight load, abnormal hormone secretion and environmental factors were included in non-nutritional factors. The growth and nutrition of children with cerebral palsy closely related with their own health and the therapeutic effects. The relevant reports on growth and nutritional status with related factors in Chinese children with cerebral palsy were rare.Immuno-inflammatory responses were considered involved in the diseases of the central nervous system and mediated the perinatal brain damage of the fetus, and they were the important factors causing cerebral palsy. Studies have found that sustained immune functional changes and the disorders of the immune adjustment mechanisms were existed in children with cerebral palsy, which could lead to the increase of infection rate and had a bad effect on the rehabilitation treatment. Various researches about the immune status of cerebral palsy were not the same, and the mechanism of cerebral palsy was still not clear. This study focused on the cellular immune status of children with cerebral palsy and identification of its related factors.ObjectiveThe aim of the study was to assess the nutritional and cellular immune status of children with cerebral palsy, then identify the related factors, and provide basis for clinical prevention and intervention measurements.Methods1. Children under 5 years old diagnosed with cerebral palsy in the centers for cerebral palsy rehabilitation of the third affiliated hospital of Zhengzhou University in Henan province were recruited in this study from December 2013 to May 2015. Anthropometric measurements including weight, height or length, head circumference, mid-upper arm circumference, triceps skinfold thickness and subscapular skinfold thickness were measured, questionnaires were finished and medical records were collected.2. Z-scores were calculated to assess the growth and nutritional status of children with cerebral palsy, and the results were compared with the normal controls, then multiple linear regression analysis were conducted to explore the related factors affecting the nutritional status of cerebral palsy children.3. Peripheral blood samples were collected from cerebral palsy children for detecting lymphocyte subsets, and the results were compared with normal controls, then multiple linear regression analysis were conducted to explore the related factors affecting the cellular immune status of cerebral palsy children.Results1. 173 cerebral palsy children were recruited, and the normal controls from the department of children health care which were healthy in physical examinations were recruited in the same period. Peripheral blood samples were collected from 161 cerebral palsy children and 170 normal controls.2. The physical growth of children with cerebral palsy were significantly poorer than normal controls, 27(15.6%) children were undernourished with 19(11.0%) underweight, 21(12.1%) stunting, 10(5.8%) wasting, 6(3.5%) children had lower mid-upper arm circumference, 8(4.6%) children had lower triceps skinfold thickness and 9(5.2%) children had lower subscapular skinfold thickness. 24(24.3%) children were microcephaly.3. WAZ、HAZ and WHZ of cerebral palsy children were all negatively affected by feeding problems, severe cerebral palsy and low birth weight(P<0.001). HCZ was negatively affected by severe cerebral palsy and epilepsy(P<0.001). MUACZ was negatively affected by feeding problems, severe cerebral palsy and very preterm birth significantly(P<0.001). TSFZ and SSFZ were both negatively affected by feeding problems and very preterm birth(P<0.001).3. Cerebral palsy children showed a lower percentage of total T cells(P=0.002), TH cells(P=0.001)and TC cells(P=0.021)and higher percentage of NK cells(P<0.001) than normal controls.4. TH cells were negatively affected by age, TC cells were positively affected by malnutrition and negatively affected by severe cerebral palsy, the H/S ratio positively affected by severe cerebral palsy and negatively affected by malnutrition and age.Conclusions1. The growth and nutritional status in children with cerebral palsy fallen behind the normal children, severe cerebral palsy, low birth weight, very preterm birth and feeding problems increased the risk of malnutrition, nutrition surveillance and timely intervention to the children with cerebral palsy should not be ignored.2. Disordered cellular immune status in children with cerebral palsy were existed, Age, severity and nutritional status were the main factors that affecting the changes of the lymphocyte subsets of children with cerebral palsy, but the role that these changes played in the development of cerebral palsy and the effect on the treatments still need further study.