Journal Article

227 Respiratory health in cerebral palsy

Hannah, Todd, Graham, David, Parris, Claire

2023

Overview

ObjectivesRespiratory illness is the leading cause of mortality in children with cerebral palsy (CP). A consensus statement published by Gibson et al identified 9 risk factors for respiratory disease in CP predisposing to increased 5 year risk of hospital admission with associated morbidity and healthcare burden.1 The aim of this project was to evaluate the number and demographics of children in Southern Trust with CP and identify their respiratory risk factors.MethodsCase records were identified from the Cerebral Palsy Register and Child Development Clinic. The specified inclusion criteria were as follows: age <18 years, resident in Southern Trust, diagnosis of CP.The Cerebral Palsy Register provided data regarding GMFCS classification, previous seizures, swallow difficulties and drooling. The patients’ electronic healthcare records were reviewed to determine respiratory hospital admissions over the previous 12 months, antibiotic use for respiratory infections, current seizures, diagnosis and treatment of reflux, frequent snoring and paediatric review within preceding 18 months.ResultsA total of 114 patients were identified. The GMFCS classification of the patients were as follows: Level 1 (23%), Level 2 (30%), Level 3 (14%), Level 4 (14%), Level 5 (19%). 70% of patients received a paediatric review over the preceding 18 months; all GMFCS Level 5 children were reviewed. 7% had a respiratory hospital admission over past 12 months; all were, or predicted to be, GMFCS Level 5 and comparatively younger (18% <6year, 5% 6–12year, 5% 12–18year).25% of patients had swallow difficulties; of whom 94% were GMFCS Level 4 or 5. 28% drooling issues; of which 78% were GMFCS were Level 4/5. 17% of patients had seizures in preceding 12 months. 9% had frequent respiratory symptoms; all were GMFCS Level 4/5. 9% had received at least 2 antibiotics for chest infections over the preceding 12 months; 90% were GMFCS Level 4/5. 23% of children had reflux; 84% were GMFCS Level 4/5. 5% of children snored frequently; 90% were GMFCS Level 4/5.ConclusionThere are many predisposing risk factors for respiratory hospital admission that can be challenging to recall in the outpatient setting. Children with GMFCS 4/5 have concomitant respiratory risk factors. Children <6 years appear to have greater risk of respiratory hospital admission. The findings suggest the introduction of a respiratory checklist for children with GMFCS 4/5 could ensure the modifiable risk factors are identified, optimised and prompt timely referral to a respiratory specialist.ReferenceGibson N, Blackmore AM, Chang AB, Cooper MS, Jaffe A, Kong WR, Langdon K, Moshovis L, Pavleski K, Wilson AC. Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement. Dev Med Child Neurol. 2021 Feb;63(2):172–182. doi: 10.1111/dmcn.14640. Epub 2020 Aug 9. PMID: 32803795; PMCID: PMC7818421.

• Publisher: BMJ Publishing Group LTD
• Subject: Antibiotics / Case Records / Cerebral palsy / Child Development / Children / Classification / Diagnosis / Health care / Hospitals / Morbidity / Paralysis / Patients / Pediatrics / Respiratory diseases / Risk factors / Saliva / Seizures