Neurological Impairment

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Peter B Sullivan - One of the best experts on this subject based on the ideXlab platform.

  • top ten tips for managing nutritional issues and gastrointestinal symptoms in children with Neurological Impairment
    Italian Journal of Pediatrics, 2020
    Co-Authors: Valeria Dipasquale, Peter B Sullivan, F Gottrand, Claudio Romano
    Abstract:

    The prevalence of children with Neurological Impairment (NI) presenting feeding difficulties and gastrointestinal symptoms is rising. The most recent guidelines recommend early nutritional assessment and intervention in order to prevent undernutrition and growth failure, along with the proper diagnosis and treatment of some frequent gastrointestinal symptoms, such as gastroesophageal reflux disease (GERD) and constipation, which can further worsen the feeding process and nutritional status. Nonetheless, the nutritional issues and growth deficits of children with NI are often considered to be of low priority or under recognised by healthcare providers. The present article proposes ten top tips that highlight the major points along the nutritional management pathway of NI children. The implementation of these tips in all healthcare settings could potentially improve patient outcomes and reduce morbidity and mortality.

  • g29 optimising nutrition to improve growth and reduce neurodisabilities in neonates at risk of Neurological Impairment
    Archives of Disease in Childhood, 2016
    Co-Authors: Morag J Andrew, Jeremy R Parr, Chris Montaguejohnson, Oliver Braddick, Karen Laler, Bonny Baker, Jane Holmes, J Atkinson, Peter B Sullivan
    Abstract:

    Background Docosahexaenoic acid (DHA), choline and uridine-5-monophosphate (UMP) are important brain nutrients which form phosphatidylcholine, the most abundant brain membrane phospholipid. DHA, choline and UMP supplementation increases rodent brain phospholipids, synaptic components, functional brain connectivity and cognitive performance. This novel pilot study supplemented infants at risk of Neurological Impairment (ARNI) with a nutrient combination containing these neurotrophic compounds. Aim In a double blind randomised control trial (RCT), investigate if intake of a specific nutrient combination improves neurodevelopmental outcome in infants ARNI. Method Recruitment was from UK neonatal units. Eligibility: ≤31 weeks, weight <9th percentile; <31 weeks with ≥ Grade II intraventricular haemorrhage (IVH) or preterm white matter injury (PWMI); 31–40 weeks with ≥ Grade II IVH or PWMI, ≥ Sarnat Grade II hypoxic ischaemic encephalopathy or defined brain MRI abnormalities. Stratification was by gender, gestation and brain injury severity. Randomised infants received neurotrophic supplementation or placebo, for 2 years. Primary outcome was Bayley Scales of Infant Development III (BSID III) composite cognitive score (CCS) after 2 years. Secondary outcomes included BSID III composite language score (CLS) and BSID III composite motor score (CMS). Local Ethics Committee approval was granted. Results 62 neonates were recruited. After 2 years, mean CCS in the intervention group was 87.7 (SD 20.4) and 81.6 (SD 18.5) in the placebo group (χ2(1)=2.28, p = 0.13; −0.2, 18.2). Mean CLS in the intervention group was 91.5 (SD 20.1) and 83.2 (SD 19.6) in the placebo group (χ2(1)=2.74, p = 0.1; −2.4, 18.3). CMS was similar in both groups. Conclusion The difference in CCS and CLS between intervention and placebo groups represents a clinically significant effect size. Use of neurotrophic micronutrient supplementation in infants ARNI warrants exploration in a large multicentre RCT.

  • optimising nutrition to improve growth and reduce neurodisabilities in neonates at risk of Neurological Impairment and children with suspected or confirmed cerebral palsy
    BMC Pediatrics, 2015
    Co-Authors: Morag J Andrew, Jeremy R Parr, Chris Montaguejohnson, Oliver Braddick, Karen Laler, Nicola Williams, Bonny Baker, Peter B Sullivan
    Abstract:

    Neurological Impairment is a common sequelae of perinatal brain injury. Plasticity of the developing brain is due to a rich substrate of developing neurones, synaptic elements and extracellular matrix. Interventions supporting this inherent capacity for plasticity may improve the developmental outcome of infants following brain injury. Nutritional supplementation with combination docosahexaenoic acid, uridine and choline has been shown to increase synaptic elements, dendritic density and neurotransmitter release in rodents, improving performance on cognitive tests. It remains elusive whether such specific ‘neurotrophic’ supplementation enhances brain plasticity and repair after perinatal brain injury. This is a two year double-blind, randomised placebo controlled study with two cohorts to investigate whether nutritional intervention with a neurotrophic dietary supplement improves growth and neurodevelopmental outcomes in neonates at significant risk of Neurological Impairment (the D1 cohort), and infants with suspected or confirmed cerebral palsy (the D2 cohort). 120 children will be randomised to receive dietetic and nutritional intervention, and either active supplement or placebo. Eligible D1 neonates are those born <30+6 weeks gestation with weight <9th centile, ≤30+6 weeks gestation and Grade II, III or IV Intra-Ventricular Haemorrhage or periventricular white matter injury, or those born at 31-40+28 weeks gestation, with Sarnat grade I or II or III Hypoxic Ischaemic Encephalopathy or neuroimaging changes compatible with perinatal brain injury. Eligible D2 infants are those aged 1-18 months with a suspected or confirmed clinical diagnosis of cerebral palsy. The primary outcome measure is composite cognitive score on the Bayley Scales of Infant and Toddler Development III at 24 months. Secondary outcomes include visuobehavioural and visual neurophysiological assessments, and growth parameters including weight, height, and head circumference. This is the first study to supplement neonates and infants with perinatal brain injury with the combination of factors required for healthy brain development, throughout the period of maximal brain growth. A further study strength is the comprehensive range of outcome measures employed. If beneficial, supplementation with brain phosphatide precursors could improve the quality of life of thousands of children with perinatal brain injury. Current Controlled trials: ISRCTN39264076 (registration assigned 09/11/2012), ISRCTN15239951 (registration assigned 23/04/2010).

  • fundoplication versus postoperative medication for gastro oesophageal reflux in children with Neurological Impairment undergoing gastrostomy
    Cochrane Database of Systematic Reviews, 2013
    Co-Authors: Angharad Vernonroberts, Peter B Sullivan
    Abstract:

    Background Children with Neurological Impairments frequently experience feeding difficulties, which can lead to malnutrition and growth failure. Gastrostomy feeding is now the preferred method of providing nutritional support to children with Neurological Impairments who are unable to feed adequately by mouth. Complications may arise as a result of gastrostomy placement, and the development or worsening of gastro-oesophageal reflux (GOR) has been widely reported. This has led to the frequent use of surgical antireflux treatment in the form of a fundoplication, or other antireflux procedures. Fundoplication is associated with a high recurrence rate, surgical failure, and significant morbidity and mortality. Since proton pump inhibitors (PPIs) were introduced in the 1990s, they have come to play a larger part in the medical management of GOR in children with Neurological Impairments. Uncontrolled studies suggest that PPIs may be a safe, appropriate treatment for GOR. Other agents currently used include milk thickeners, acid suppression drugs, acid buffering agents, gut motility stimulants and sodium alginate preparations. There are risks and benefits associated with both surgical and medical interventions and further comparison is necessary to determine the optimal treatment choice. Objectives To compare the effectiveness of antireflux surgery and antireflux medications for children with Neurological Impairments and GOR who are undergoing placement of a gastrostomy feeding tube. Search methods We searched the following databases on 23 March 2012: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, CINAHL, LILACS and ISI Web of Science. Previously, we searched the Child Health Library in June 2009. We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses. We contacted specialists in the medical and industry setting for knowledge of completed or ongoing trials. Selection criteria We sought to include randomised controlled trials that recruited children up to the age of 18 years with Neurological Impairments and GOR who were undergoing gastrostomy tube insertion. Data collection and analysis The review authors worked independently to select trials; none were identified. Main results We identified no trials that satisfied the criteria for this review. Authors' conclusions There remains considerable uncertainty regarding the optimal treatment when faced with the decision of fundoplication surgery versus antireflux medications for children with GOR and Neurological Impairment who are undergoing gastrostomy insertion. There is a need for robust scientific evidence in order to provide data on the comparable risks or benefits of the two interventions.

  • prevalence and severity of feeding and nutritional problems in children with Neurological Impairment oxford feeding study
    Developmental Medicine & Child Neurology, 2000
    Co-Authors: Peter B Sullivan, B Lambert, M Rose, M Fordadams, Ann Johnson, P Griffiths
    Abstract:

    The aim of this study was to estimate the prevalence and severity of feeding and nutritional problems in children with Neurological Impairment within a defined geographical area. In a cross-sectional study, a validated questionnaire was sent to 377 parents of children (aged 4 to 13 years) on the Oxford Register of Early Childhood Impairments with oromotor dysfunction. The return rate was 72%. Of these, 93% had cerebral palsy; 47% were unable to walk; 78% had speech difficulty; and 28% continuous drooling of saliva. Gastrointestinal problems were commonly encountered: 59% were constipated; 22% had significant problems with vomiting, and 31% had suffered at least one chest infection in the previous 6 months. Feeding problems were prevalent: 89% needed help with feeding and 56% choked with food; 20% of parents described feeding as stressful and unenjoyable. Prolonged feeding times (3h/day) were reported by 28%. Only 8% of participants received caloric supplements and 8% were fed via gastrostomy tube. Even though 38% of respondents considered their child to be underweight, 64% of children had never had their feeding and nutrition assessed. The results highlight that feeding problems in children with Neurological Impairment are common and severe, causing parental concern. Many of these children would benefit from nutritional assessment and management as part of their overall care.

Rajendu Srivastava - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of fundoplication at the time of gastrostomy in infants with Neurological Impairment
    JAMA Pediatrics, 2013
    Co-Authors: Douglas C Barnhart, Jay G Berry, Michael J Dean, Matt Hall, Sanjay Mahant, Adam B Goldin, Roger G Faix, Rajendu Srivastava
    Abstract:

    Importance Gastrostomy tube (GT) placement is the most common gastrointestinal operation performed on neonates. Concomitant fundoplication is used variably to prevent complications of gastroesophageal reflux, but its effectiveness is unproven. Objective To compare the effect of fundoplication at the time of GT placement vs GT placement alone on subsequent reflux-related hospitalizations in infants with Neurological Impairment. Design, Setting, and Participants Retrospective, observational cohort study, defined by birth between January 1, 2005, and December 31, 2010, at 42 children’s hospitals in the United States, with a 1-year follow-up period among 4163 infants with Neurological Impairment who underwent GT placement with or without fundoplication during their neonatal intensive care unit stay. Intervention Fundoplication and GT placement vs GT placement alone. Main Outcomes and Measures One-year postprocedural reflux-related hospitalization rates, defined as hospitalization for asthma, mechanical ventilation, gastroesophageal reflux disease, and aspiration or other types of pneumonia. Propensity to undergo concomitant fundoplication was modeled using demographics, prior procedures (tracheostomy and mechanical ventilation), and prior diagnoses (eg, pneumonia, gastroesophageal reflux disease, and other comorbidities). Results Overall, 4163 of 42 796 infants (9.7%) with Neurological Impairment admitted to the neonatal intensive care unit underwent GT placement alone or with fundoplication. Infants who concomitantly underwent fundoplication had more reflux-related hospitalizations during the first year than those who underwent GT placement alone (mean, 1.02; 95% CI, 0.93-1.10 vs mean, 0.92; 95% CI, 0.91-1.00). Of 1404 infants who underwent fundoplication, 1027 (73.1%) were matched based on propensity scores. The mean difference of the matched cohort for any reflux-related hospitalizations was −0.05 (95% CI, −0.20 to 0.15) per year. Conclusions and Relevance Infants with Neurological Impairment who underwent fundoplication at the time of GT placement did not have a reduced rate of reflux-related hospitalizations during the first year compared with those who underwent GT placement alone, despite propensity score matching. This may be due to a lack of effectiveness of fundoplication in preventing these complications or due to differences in the patient groups that were inadequately accounted for in the matching.

  • trends in resource utilization by children with Neurological Impairment in the united states inpatient health care system a repeat cross sectional study
    PLOS Medicine, 2012
    Co-Authors: Jay G Berry, Annapurna Poduri, Joshua L Bonkowsky, Jing Zhou, Dionne A Graham, Chelsea Welch, Heather Putney, Rajendu Srivastava
    Abstract:

    Background Care advances in the United States (US) have led to improved survival of children with Neurological Impairment (NI). Children with NI may account for an increasing proportion of hospital resources. However, this assumption has not been tested at a national level.

  • reflux related hospital admissions after fundoplication in children with Neurological Impairment retrospective cohort study
    BMJ, 2009
    Co-Authors: Rajendu Srivastava, Jay G Berry, Matthew Hall, Earl C Downey, Molly Ogorman, Michael J Dean, Douglas C Barnhart
    Abstract:

    Objective To examine the impact of fundoplication on reflux related hospital admissions for children with Neurological Impairment. Design Retrospective, observational cohort study. Setting 42 children’s hospitals in the United States. Participants 3721 children with Neurological Impairment born between 2000 and 2005 who had at least one hospital admission at a study hospital before their fundoplication. Intervention Fundoplication. Main outcome measures Incident rate ratio for reflux related hospital admissions, defined as the post-fundoplication admission rate divided by the pre-fundoplication admission rate. Results Of the 955 285 children born during the study period, 144 749 (15%) had Neurological Impairment. Of these, 27 720 (19%) were diagnosed as having gastro-oesophageal reflux disease, of whom 6716 (24%) had a fundoplication. Of these, 3721 (55%) had at least one previous hospital admission and were included in the study cohort. After fundoplication, hospital admissions decreased for any reflux related cause (incident rate ratio 0.69, 95% confidence interval 0.67 to 0.72; P Conclusions Children with Neurological Impairment who have fundoplication had reduced short term reflux related hospital admissions for aspiration pneumonia, gastro-oesophageal reflux disease, and mechanical ventilation. However, admissions for pneumonia remained constant and those for asthma increased after fundoplication. Comparative effectiveness data for other treatments (such as gastrojejunal feeding tubes) are unknown.

  • quality of life of children with Neurological Impairment who receive a fundoplication for gastroesophageal reflux disease
    Journal of Hospital Medicine, 2007
    Co-Authors: Rajendu Srivastava, Earl C Downey, Peter Feola, Matthew H Samore, Laurie Coburn, Richard Holubkov, Michael B Mundorff, Flory L Nkoy, Dan Desrochers, Brent C James
    Abstract:

    BACKGROUND Children with Neurological Impairment (NI) commonly have gastroesophageal reflux disease (GERD) treated with a fundoplication. The impact of this procedure on quality of life is poorly understood. OBJECTIVES To examine the quality of life of children with NI who have received a fundoplication for GERD and of their caregivers. METHODS The study was a prospective cohort study of children with NI and GERD who underwent a fundoplication at a children's hospital between January 1, 2005, and July 7, 2006. Quality of life of the children was assessed with the Child Health Questionnaire (CHQ) and of the caregivers with the Short-Form Health Survey Status (SF-36) and Parenting Stress Index (PSI), both at baseline and 1 month after fundoplication. Functional status was assessed using the WeeFIM®. Repeated-measures analyses were performed. RESULTS Forty-four of the 63 parents (70%) were enrolled. The median WeeFIM® score was 31.2 versus the age-normal score of 83 (P = .001). Compared with the baseline scores, mean CHQ scores improved over 1 month in the domains of bodily pain (32.8 vs. 47.5, P = .01), role limitations–physical (30.6 vs. 56.6, P = .01), mental health (62.7 vs. 70.6, P = .01), family limitation of activities (43.3 vs. 55.1, P = .03), and parental time (43.0 vs. 55.3, P = .03). The parental SF-36 domain of vitality improved from baseline over 1 month (41.3 vs. 48.2, P = .001), but there were no changes from baseline in Parenting Stress scores. CONCLUSIONS Parents reported that the quality of life of children with NI who receive a fundoplication for GERD was improved from baseline in several domains 1 month after surgery. The quality of life and stress of caregivers did not improve in nearly all domains, at least in the short term. Journal of Hospital Medicine 2007;2:165–173. © 2007 Society of Hospital Medicine.

Elizabeth C Ward - One of the best experts on this subject based on the ideXlab platform.

  • interventions for oropharyngeal dysphagia in children with Neurological Impairment
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Angela T Morgan, Pamela Dodrill, Elizabeth C Ward
    Abstract:

    Oropharyngeal dysphagia, or swallowing difficulty, can be defined as problems with chewing and preparing food, difficulty moving food through the mouth to the back of the tongue, and difficulty with swallowing and movement of food through the 'throat' or pharynx. Many children with Neurological Impairment experience swallowing difficulties, including those with acquired brain Impairment (for example, cerebral palsy, traumatic brain injury, stroke), genetic syndromes (for example, Down syndrome, Rett syndrome) and degenerative conditions (for example, myotonic dystrophy). This review examined the effectiveness of interventions for oropharyngeal dysphagia in children with Neurological Impairment. The three studies included in the review examined oral sensorimotor treatments and lip strengthening interventions. The authors were interested in three primary outcomes, which were physiological functions of the oropharyngeal mechanism for swallowing (for example, lip seal maintenance), the presence of chest infection and pneumonia, and diet consistency, and three secondary outcomes, which were changes in growth, child's level of participation in the mealtime routine, and the level of parent or carer stress associated with feeding. The authors concluded that there is currently not enough high-quality evidence from randomised controlled trials or quasi-randomised controlled trials for any particular type of oropharyngeal dysphagia intervention in this population of children. There is a need for larger-scale randomised controlled trials to evaluate the effects of interventions for oropharyngeal dysphagia in children with Neurological Impairment.

  • The Cochrane Library - Interventions for oropharyngeal dysphagia in children with Neurological Impairment
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Angela T Morgan, Pamela Dodrill, Elizabeth C Ward
    Abstract:

    Oropharyngeal dysphagia, or swallowing difficulty, can be defined as problems with chewing and preparing food, difficulty moving food through the mouth to the back of the tongue, and difficulty with swallowing and movement of food through the 'throat' or pharynx. Many children with Neurological Impairment experience swallowing difficulties, including those with acquired brain Impairment (for example, cerebral palsy, traumatic brain injury, stroke), genetic syndromes (for example, Down syndrome, Rett syndrome) and degenerative conditions (for example, myotonic dystrophy). This review examined the effectiveness of interventions for oropharyngeal dysphagia in children with Neurological Impairment. The three studies included in the review examined oral sensorimotor treatments and lip strengthening interventions. The authors were interested in three primary outcomes, which were physiological functions of the oropharyngeal mechanism for swallowing (for example, lip seal maintenance), the presence of chest infection and pneumonia, and diet consistency, and three secondary outcomes, which were changes in growth, child's level of participation in the mealtime routine, and the level of parent or carer stress associated with feeding. The authors concluded that there is currently not enough high-quality evidence from randomised controlled trials or quasi-randomised controlled trials for any particular type of oropharyngeal dysphagia intervention in this population of children. There is a need for larger-scale randomised controlled trials to evaluate the effects of interventions for oropharyngeal dysphagia in children with Neurological Impairment.

Langston T Holly - One of the best experts on this subject based on the ideXlab platform.

  • prediction of Neurological Impairment in cervical spondylotic myelopathy using a combination of diffusion mri and proton mr spectroscopy
    PLOS ONE, 2015
    Co-Authors: Benjamin M Ellingson, Noriko Salamon, Anthony J Hardy, Langston T Holly
    Abstract:

    Purpose In the present study we investigated a combination of diffusion tensor imaging (DTI) and magnetic resonance spectroscopic (MRS) biomarkers in order to predict Neurological Impairment in patients with cervical spondylosis.

  • correlation between degree of subvoxel spinal cord compression measured with super resolution tract density imaging and Neurological Impairment in cervical spondylotic myelopathy
    Journal of Neurosurgery, 2015
    Co-Authors: Benjamin M Ellingson, Noriko Salamon, Davis C Woodworth, Langston T Holly
    Abstract:

    OBJECT The purpose of this study was to explore the use of super-resolution tract density images derived from probabilistic diffusion tensor imaging (DTI) tractography of the spinal cord as an imaging surrogate for microstructural integrity and functional Impairment in patients with cervical spondylosis. METHODS Structural MRI and DTI images were collected for 27 patients with cervical spondylosis with (n= 21) and without (n= 6) functional Impairment as defined by the modified Japanese Orthopaedic Association Scale (mJOA). DTI was performed axially through the site of compression in a total of 20 directions with 10 averages. Probabilistic tractography was performed at 0.5-mm isotropic spatial resolution using the streamline technique combined with constrained spherical deconvolution. The following measurements were calculated for each patient: maximum tract density at the site of compression, average tract density in rostral normal-appearing spinal cord, and the ratio of maximum density to normal density. RESULTS Compared with normal tissue, the site of compression exhibited elevated fiber tract density in all patients, and a higher fiber tract density was also noted in focal areas at the site of compression in patients with functional Impairment. There was a strong negative correlation between maximum tract density and mJOA score (R(2)= 0.6324, p < 0.0001) and the ratio of maximum tract density to normal tract density (R(2)= 0.6647, p < 0.0001). When grouped according to severity of Neurological Impairment (asymptomatic, mJOA score of 18; mild, mJOA score of 15-17; moderate, mJOA score of 11-14; and severe, mJOA score < 11), the results showed a significant difference in the ratio between severe and both no Impairment (p= 0.0009) and any Impairment (p= 0.036). A ratio of maximum fiber tract density at the site of compression to fiber tract density at C-2 greater than 1.45 had 82% sensitivity and 70% specificity for identifying patients with moderate to severe Impairment (ROC AUC= 0.8882, p= 0.0009). CONCLUSIONS These results support the use of DTI as a surrogate for determining spinal cord integrity in patients with cervical spondylosis. Probabilistic tractography provides spinal cord microstructural information that can help discern clinical status in cervical spondylosis patients with varying degrees of Neurological Impairment.

Vicki Anderson - One of the best experts on this subject based on the ideXlab platform.

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