Pulmonary Disorders and Problems in Children with Cerebral Palsy

Abstract

Aim: This review aims to analyze the most common pulmonary problems in children with cerebral palsy and to identify the predisposing factors that contribute to their development.

Materials and Methods: Articles identified in PubMed, Scopus, Google Scholar databases for the period July-August 2023 were included in the study, where a total of 153 articles were found. After removing duplicates and articles that did not meet the inclusion criteria, 26 articles remained and were subjected to a thorough analysis.

Results: The analysis showed that children with cerebral palsy are at high risk of respiratory infections and ventilatory disorders due to specific anatomical and physiological challenges. The importance of early diagnosis and a personalised approach to treatment and prevention to tackle these problems effectively is emphasised.

Conclusion: This study highlights the critical need for a multidisciplinary approach in the management of pulmonary problems in children with cerebral palsy. This includes integrating early diagnosis, adequate rehabilitation and preventive strategies to improve quality of life and reduce mortality.

Key words: cerebral palsy, lung problems, infections, pulmonary function

To access this content, you must purchase Годишен абонамент.

Bibliography

  1. В. Божинова, Ив. Чавдаров, И. Миланов, Национален консенсус за диагностика, рехабилитация, лечение и администриране на деца с церебрална парализа 2019 г.,  Българско дружество по детска неврология, психиатрия и психология на развитието Асоциация по физикална медицина и рехабилитация Българско дружество по неврология. http://www.nevrologiabg.com/wp-content/uploads/2015/06/consensusDCP2019_deca-s-cerebralna-paraliza_bg.pdf
  2. Reddihough DS, Collins KJ. The epidemiology and causes of cerebral palsy. Aust J Physiother. 2003;49(1):7-12. doi: 10.1016/s0004-9514(14)60183-5.
  3. Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013 Jun;55(6):509-19. doi: 10.1111/dmcn.12080.
  4. Graham D, Paget SP, Wimalasundera N. Current thinking in the health care management of children with cerebral palsy. Med J Aust. 2019 Feb;210(3):129-135. doi: 10.5694/mja2.12106.
  5. Hafifah C, Setyanto D, Putra S, Mangunatmadja I, Sari T, Wulandari H. Gross motor dysfunction as a risk factor for aspiration pneumonia in children with cerebral palsy. Paediatr. Indones  2018 Jan; 57(5):229-3, doi: 10.14238/pi57.5.2017.229-33.
  6. Lagos-Guimarães HN, Teive HA, Celli A et al Aspiration Pneumonia in Children with Cerebral Palsy after Videofluoroscopic Swallowing Study. Int Arch Otorhinolaryngol. 2016 Apr;20(2):132-7. doi: 10.1055/s-0035-1566093..
  7. Benfer KA, Weir KA, Ware RS, Davies PSW, Arvedson J, Boyd RN, Bell KL. Parent-reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool-aged children with cerebral palsy. Dev Med Child Neurol. 2017 Nov;59(11):1181-1187. doi: 10.1111/dmcn.13498.
  8. Boel L, Pernet K, Toussaint M et al Respiratory morbidity in children with cerebral palsy: an overview. Dev Med Child Neurol. 2019 Jun;61(6):646-653. doi: 10.1111/dmcn.14060.
  9. Reddihough DS, Baikie G, Walstab JE. Cerebral palsy in Victoria, Australia: mortality and causes of death. J Paediatr Child Health. 2001 Apr;37(2):183-6. doi: 10.1046/j.1440-1754.2001.00644.x.
  10. Malarvizhi D, Gayathri G. V, Aamir P. N. M. Peak Expiratory Flow Rate in Children with Multiple Neurological Disorder. Biomed Pharmacol J 2020 Dec;13: 2117–2120, doi: 10.13005/bpj/2093.
  11. Wang HY, Chen CC, Hsiao SF. Relationships between respiratory muscle strength and daily living function in children with cerebral palsy. Res Dev Disabil. 2012 Jul-Aug;33(4):1176-82. doi: 10.1016/j.ridd.2012.02.004.
  12. Kuo TJ, Hsu CL, Liao PH, Huang SJ, Hung YM, Yin CH. Nomogram for pneumonia prediction among children and young people with cerebral palsy: A population-based cohort study. PLoS One. 2020 Jul 6;15(7):e0235069. doi: 10.1371/journal.pone.0235069.
  13. Jonnalagadda S, Rodríguez O, Estrella B, Sabin LL, Sempértegui F, Hamer DH. Etiology of severe pneumonia in Ecuadorian children. PLoS One. 2017 Feb 9;12(2):e0171687. doi: 10.1371/journal.pone.0171687.
  14. Lambert I, Matthews TG, Clarke TA. Bronchopulmonary dysplasia: a longitudinal study of 23 cases. Ir J Med Sci. 1991 Oct;160(10):315-6. doi: 10.1007/BF02957861.
  15. Antunes LA, Talini C, Carvalho BCN et al. Laryngotracheal separation in pediatric patients: 13-year experience in a reference service. Einstein (Sao Paulo). 2019 Jun 3;17(3):eAO4467. doi: 10.31744/einstein_journal/2019AO4467.
  16. Kürtül Çakar M, Cinel G. The respiratory problems of patients with cerebral palsy requiring hospitalization: Reasons and solutions. Pediatr Pulmonol. 2021 Jun;56(6):1626-1634. doi: 10.1002/ppul.25306
  17. В. Дулева, С. Петрова, Л. Рангелова, Е. Чикова-Ишченер, К. Ватралова, Основни аспекти и указания за хранене на деца с неврологични увреждания и умствена изостаналост, Българско списание за обществено здраве 2012, 4, 59–70.
  18. Santoro A, Lang MB, Moretti E et al A proposed multidisciplinary approach for identifying feeding abnormalities in children with cerebral palsy. J Child Neurol. 2012 Jun;27(6):708-12. doi: 10.1177/0883073811424083
  19. Leonard M, Dain E, Pelc K, Dan B, De Laet C. Nutritional status of neurologically impaired children: Impact on comorbidity. Arch Pediatr. 2020 Feb;27(2):95-103. doi: 10.1016/j.arcped.2019.11.003.
  20. Kwon YH, Lee HY. Differences in respiratory pressure and pulmonary function among children with spastic diplegic and hemiplegic cerebral palsy in comparison with normal controls. J Phys Ther Sci. 2015 Feb;27(2):401-3. doi: 10.1589/jpts.27.401
  21. Choi JY, Rha DW, Park ES. Change in Pulmonary Function after Incentive Spirometer Exercise in Children with Spastic Cerebral Palsy: A Randomized Controlled Study. Yonsei Med J. 2016 May;57(3):769-75. doi: 10.3349/ymj.2016.57.3.769.
  22. Bjure J, Berg K. Dynamic and static lung volumes of school children with cerebral palsy. Acta Paediatr Scand Suppl. 1970;204:Suppl 204:35+. doi: 10.1111/j.1651-2227.1970.tb06140.x. 
  23. Chiang KL, Huang CY, Fan HC, Kuo FC. Prolonged length of stay for acute hospital admissions as the increasing of age: A nationwide population study for Taiwan’s patients with cerebral palsy. Pediatr Neonatol. 2019 Feb;60(1):74-82. doi: 10.1016/j.pedneo.2018.04.004
  24. Young NL, McCormick AM, Gilbert T et al. Reasons for hospital admissions among youth and young adults with cerebral palsy. Arch Phys Med Rehabil. 2011 Jan;92(1):46-50. doi: 10.1016/j.apmr.2010.10.002
  25. Proesmans M, Vermeulen F, Boon M. Understanding and managing respiratory infections in children and young adults with neurological impairment. Expert Rev Respir Med. 2023 Mar;17(3):203-211. doi: 10.1080/17476348.2023.2192483
  26. Brandenburg JE, Fogarty MJ, Sieck GC. Why individuals with cerebral palsy are at higher risk for respiratory complications from COVID-19. J Pediatr Rehabil Med. 2020;13(3):317-327. doi: 10.3233/PRM-200746
  27. Whitney DG, Xu T, Berri M. Post-fracture pneumonia risk and association with health and survival outcomes for adults with cerebral palsy: A retrospective cohort study. Bone. 2022 Jun;159:116390. doi: 10.1016/j.bone.2022.116390. 
  28. Manrique D, Sato J. Salivary gland surgery for control of chronic pulmonary aspiration in children with cerebral palsy. Int J Pediatr Otorhinolaryngol. 2009 Sep;73(9):1192-4. doi: 10.1016/j.ijporl.2009.05.002.
  29. Piccione JC, McPhail GL, Fenchel MC, Brody AS, Boesch RP. Bronchiectasis in chronic pulmonary aspiration: risk factors and clinical implications. Pediatr Pulmonol. 2012 May;47(5):447-52. doi: 10.1002/ppul.21587
  30. Fitzgerald DA, Follett J, Van Asperen PP. Assessing and managing lung disease and sleep disordered breathing in children with cerebral palsy. Paediatr Respir Rev. 2009 Mar;10(1):18-24. doi: 10.1016/j.prrv.2008.10.003.
  31. Dassios T, Greenough A. Long-term sequelae of BPD. In: Sinha IP, Bhatt JM, Cleator A, et al., eds. Respiratory Diseases of the Newborn Infant (ERS Monograph). Sheffield, European Respiratory Society, 2021; pp. 68–78, doi:10.1183/2312508X.10013720].
  32. В. Божинова, Диагноза и диференциална диагноза при деца с двигателен дефицит, сп. Педиатрия 2007, 47 (супл.), 9–15.
  33. Родопска Е, Божинова В, Топалов  Е  и кол.  Диференциална диагноза на детската церебрална парализа,  GPNews 2020, 3,22-27
  34. Kumar N, Aggarwal P, Dev N, Kumar G. Ataxia telangiectasia: learning from previous mistakes. BMJ Case Rep. 2012 Dec 14;2012:bcr2012007246. doi: 10.1136/bcr-2012-007246.
  35. Blatter JA, Finder JD. Perioperative respiratory management of pediatric patients with neuromuscular disease. Paediatr Anaesth. 2013 Sep;23(9):770-6. doi: 10.1111/pan.12214. 
  36. Inan M, Senaran H, Domzalski M, Littleton A, Dabney K, Miller F. Unilateral versus bilateral peri-ilial pelvic osteotomies combined with proximal femoral osteotomies in children with cerebral palsy: perioperative complications. J Pediatr Orthop. 2006 Jul-Aug;26(4):547-50. doi: 10.1097/01.bpo.0000226277.08825.c2
  37. Neuhäuser C, Wagner B, Heckmann M, Weigand MA, Zimmer KP. Analgesia and sedation for painful interventions in children and adolescents. Dtsch Arztebl Int. 2010 Apr;107(14):241-7, I-II, I. doi: 10.3238/arztebl.2010.0241.
  38. Gustave J, Shenoy A Medical Management of Tracheostomy in the Child with Cerebral Palsy, In Cerebral Palsy, F. Miller, S. Bachrach, N. Lennon, and M. E. O’Neil, Eds., Cham: Springer International Publishing, 2020, pp. 937–948. doi: 10.1007/978-3-319-74558-9_70.
  39. Marpole R, Blackmore AM, Gibson N, Cooper MS, Langdon K, Wilson AC. Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy. Front Pediatr. 2020 Jun 24;8:333. doi: 10.3389/fped.2020.00333.
  40. Noritz G, Pulmonary Management of the Patient with Cerebral Palsy. In: Panteliadis, C. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-67858-0_29.
  41. Takahashi K. [Treatment of respiratory disturbance in children with severe physical disabilities to improve their quality of life]. No To Hattatsu. 2003 May;35(3):215-21.

Address for correspondence

First Department of Internal Disease,

Medical University  – Varna

1 “Hristo Smirnenski”, Blvd.

9010, Varna

Bulgaria

e-mail: p.peneva@abv.bg