Nutritional support for children with cerebral palsy: experience in the use of oedematous enteral nutrition in children
T. L. Pilat,
E. P. Tropina,
V. A. Zmanovskaya,
O. N. Zhivaeva,
V. S. Anikina,
Yu. G. Kuznetsova,
T. V. Lyapunova,
D. A. Semin https://doi.org/10.21518/ms2025-301
Abstract
Introduction. Increased protein and energy requirements, high levels of inflammatory response, osteopenia, and endogenous intoxication syndrome in patients with cerebral palsy determine the need to use therapeutic enteral mixtures with a metabolic focus (EMF) in their nutrition.
Aim. Evaluate the clinical efficacy and tolerability of the use of domestic therapeutic nutrition (nutritive support (NS) – ESMN Detoxifying Protein Cocktail NUTRIO and Bone Tissue Cocktail (protein) in children with cerebral palsy.
Materials and methods. A comparative prospective study was conducted at the State Healthcare Institution of the Tyumen Region, the Children’s and Rehabilitation Center Nadezhda. 39 children with cerebral palsy aged 3 to 18 years with a severity of motor impairment of GMFCS III-V were observed. All patients were divided into 4 groups depending on their age and nutritional support: 1st main (n = 5) aged 3–8 years with NS; 1st control (n = 5) without NS; 2nd main (n = 21) aged 9–17 years with NS; 2nd control (n = 8) without NS. The study period was 30 days. Before and After the study, the general condition of the children, nutritional status, anthropometry, densitometry, as well as blood parameters and markers of inflammation and intoxication were assessed.
Results. Against the background of nutritional support, the following was observed: statistically significant increase in body weight, height, z-score of body weight, mainly due to skeletal muscle mass; an increase in the level of protein and albumin in the blood; a decrease in markers of intoxication and inflammation; an increase in bone mineral density.
Conclusions. The Protein Detoxification Cocktail NUTRIO and Bone Tissue Cocktail (protein) in diet therapy for children with cerebral palsy is effective in correcting their nutritional status, preventing the development of osteopenia, reducing inflammation and intoxication and improving the quality of life.
About the Authors
T. L. Pilat
Research Institute of Occupational Medicine named after Academician N.F. Izmerov
Russian Federation
Russian Federation
Tatiana L. Pilat - Dr. Sci. (Med.), Leading Researcher, Izmerov Research Institute of Occupational Health.
31, Budyonny Ave., Moscow, 105275
E. P. Tropina
Children’s Medical and Rehabilitation Center “Nadezhda”
Russian Federation
Russian Federation
Elena P. Tropina - Head of the Center for Palliative Medical Care for Children, Children’s Medical and Rehabilitation Center “Nadezhda”.
1, Bldg. 2, Slavyanskaya St., Tyumen, 625043
V. A. Zmanovskaya
Children’s Medical and Rehabilitation Center “Nadezhda”
Russian Federation
Russian Federation
Vera A. Zmanovskaya - Cand. Sci. (Med.), Neurologist, Chief Freelance Specialist in Rehabilitation Care for Children of the Tyumen region, Chief Physician, Children’s Medical and Rehabilitation Center “Nadezhda”.
1, Bldg. 2, Slavyanskaya St., Tyumen, 625043
O. N. Zhivaeva
Children’s Medical and Rehabilitation Center “Nadezhda”
Russian Federation
Russian Federation
Olga N. Zhivaeva - Pediatrician of the Center for Palliative Medical Care for Children, Children’s Medical and Rehabilitation Center “Nadezhda”.
1, Bldg. 2, Slavyanskaya St., Tyumen, 625043
V. S. Anikina
Children’s Medical and Rehabilitation Center “Nadezhda”
Russian Federation
Russian Federation
Vera S. Anikina - Pediatrician at the Center for Palliative Medical Care for Children, Children’s Medical and Rehabilitation Center “Nadezhda”.
1, Bldg. 2, Slavyanskaya St., Tyumen, 625043
Yu. G. Kuznetsova
Central State Medical Academy of the Administration of the President of the Russian Federation
Russian Federation
Russian Federation
Yulia G. Kuznetsova - Cand. Sci. (Med.), Assistant Professor, Department of Gastroenterology, Central State Medical Academy of the Administration of the President of the Russian Federation.
19, Bldg. 1a, Marshal Timoshenko St., Moscow, 121359
T. V. Lyapunova
Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Tatiana V. Lyapunova - Cand. Sci. (Med.), Associate Professor of the Department of Medical Informatics and Telemedicine at the Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba.
6, Miklukho-Maklai St., Moscow, 117198
D. A. Semin
Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Dmitriy A. Semin - Assistant of the Department of Nursing Management, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba.
6, Miklukho-Maklai St., Moscow, 117198
References
1. Строкова ТВ. Оценка пищевого статуса, способы его коррекции и принципы нутритивной поддержки у детей с детским церебральным параличом. М.: Группа Развитие; 2023. 120 с. Режим доступа: https://expose.gpntbsib.ru/expose/novye-postupleniya-po-medicine-29-noyabrya-2023-g.-34777438/book/Д2023-1613516414547.
2. McIntyre S, Goldsmith S, Webb A, Ehlinger V, Hollung SJ, McConnell K et al. Global prevalence of cerebral palsy: A systematic analysis. Dev Med Child Neurol. 2022;64(12):1494–1506. https://doi.org/10.1111/dmcn.15346
3. Баранов АА, Намазова-Баранова ЛС, Кузенкова ЛМ, Куренков АЛ, Клочкова ОА, Мамедъяров АМ и др. Федеральные клинические рекомендации по оказанию медицинской помощи детям с детским церебральным параличом. М.; 2016. 36 с. Режим доступа: https://www.pediatr-russia.ru/information/klin-rek/deystvuyushchie-klinicheskie-rekomendatsii/index.php.
4. Batysheva TT, Bykova OV, Tyurina EM, Vinogradov AV Cerebral palsy in children – a current review. Doctor.Ru. 2012;(5):40–44. (In Russ.) Available at: https://elibrary.ru/pjbpyp.
5. Gaysina LZ, Gainetdinova DD, Khakimova RF. Neuroimmunological aspects of pathogenesis of cerebral palsy. Medical Immunology. 2011;13(2-3):115–120. (In Russ.) https://doi.org/10.15789/1563-0625-2011-2-3-115-120.
6. Artykova MА. Level immune response mediators in children with epilepsy thebackground cerebral palsy. Problems of Biology and Medicine. 2016;(4):29–31. (In Russ.) Available at: https://inlibrary.uz/index.php/problems_biology/article/view/3701.
7. Pichkur LD, Rudenko LD. Dynamics of indices of cellular immunity and neuroautoimmune reactions in patients with spastic forms of cerebral palsy at the stages of rehabilitation treatment using embryonic nervous tissue. Ukrainian Neurosurgical Journal. 2000;(4):121–125. (In Russ.) Available at: https://cyberleninka.ru/article/n/dinamika-pokazateley-kletochnogo-immuniteta-i-neyroautoimmunnyh-reaktsiy-u-bolnyh-so-spasticheskimi-formami-dtsp-na-etapah.
8. Gibson CS, Maclennan AH, Dekker GA, Goldwater PN, Sullivan TR, Munroe DJ et al. Candidate genes and cerebral palsy: a population-based study. Pediatrics. 2008;122(5):1079–1085. https://doi.org/10.1542/peds.2007-3758.
9. Afandieva LZ, Gainetdinova DD. Gross motor functions and immune parameters in children with spastic cerebral palsy: is there a link. Practical Medicine. 2023;(4). (In Russ.) Available at: https://pmarchive.ru/bolshie-motornye-funkcii-i-immunnye-pokazateli-u-detej-so-spasticheskim-cerebralnym-paralichom-est-li-svyaz.
10. Henderson RC, Lark RK, Gurka MJ, Worley G, Fung EB, Conaway M et al. Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrics. 2002;110(1 Pt 1):e5. https://doi.org/10.1542/peds.110.1.e5.
11. Henderson RC, Kairalla JA, Barrington JW. Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy. J Pediatr. 2005;146(6):769–775. https://doi.org/0.1016/j.jpeds.2005.02.024.
12. Galashevskaya AA, Pochkaylo AS. Modern approaches to prevention and treatment of osteoporosis in children with cerebral palsy. Paediatrics. Eastern Europe. 2021;9(1):94–106. (In Russ.) https://doi.org/10.34883/PI.2021.9.1.008.
13. Ko A, Kong J, Samadov F, Mukhamedov A, Kim Y, Lee Y et al. Bone health in pediatric patients with neurological disorders. Ann Pediatr Endocrinol Metab. 2020;25(1):15–23. https://doi.org/10.6065/apem.2020.25.1.15.
14. Nurković JS, Petković P, Tiosavljević D, Vojinović R. Measurement of bone mineral density in children with cerebral palsy from an ethical issue to a diagnostic necessity. Biomed Res Int. 2020;2020:7282946. https://doi.org/10.1155/2020/7282946.
15. Barbier V, Goeb V, Gouron R, Fritot S, Mentaverri R, Klein C. Bone health in children with severe cerebral palsy. Front Pediatr. 2023;11:1264111. https://doi.org/10.3389/fped.2023.
16. Maslova NA, Zvonkova NG, Borovik TE, Fisenko AP, Bushueva TV, Kuzenkova LM et al. Сhanges in bone metabolism during cerebral palsy. Russian Pediatric Journal. 2022;25(2):76–83. (In Russ.) https://doi.org/10.46563/1560-9561-2022-25-2-76-83.
17. Kharchenko SS, Guseva NA, Lobanov MN, Kozhevnikov VV, Grigoricheva LG. Bone mineral density in children diagnosed with cerebral palsy after reconstructive surgeries on the hip joint. Osteoporosis and Bone Diseases. 2016;19(2):99–99. (In Russ.) https://doi.org/10.14341/osteo2016299-99.
18. Brizhan LK, Nelin NI, Pilat TL, Rakhmanova AB, Fateev AV. Efficiency of specialized therapeutic enteral nutrition in patients with bone tissue damage. Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko. 2024;(3):22–34. (In Russ.) https://doi.org/10.53652/2782-1730-2024-5-3-46-58.
19. Бадалян ЛО. Невропатология. 8-е изд. М.: Академия; 2013. 396 с. Режим доступа: https://search.rsl.ru/ru/record/01006709407.
20. Alferova VV, Uzbekov MG, Misionzhnik ÉIu, Luk’ianiuk EV, Gekht AB, Shklovskiĭ VM. Endogenous intoxication and compensatory reactions in the restoration period of ischemic stroke. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2010;110(4-2):36–41. (In Russ.) Available at: https://www.mediasphera.ru/issues/zhurnal-nevrologii-i-psikhiatrii-im-s-s-korsakova-2/2010/4-2/031997-7298201046.
21. Uzbekov MG. Non-specific syndrome of endogenous intoxication as an integral component of the pathogenesis of mental disorders. Rossijskij Psihiatriceskij Zurnal. 2000;(4):56–65. (In Russ.) Available at: http://mniip-repo.ru/view_statiy.php?id=1506.
22. Salekhov SA, Salekhova MP. Pathogenetic significance of hypodynamia in the development of somatopsychic pathology. Vestnik KazNMU. 2013;(5-1):408–410. (In Russ.) Available at: https://www.elibrary.ru/xyoyqp.
23. Tropina EP, Zmanovskaya VA, Zhivaeva ON, Guseva EN, Anikina VS. Orphan diseases in children: experience in the use of oedematous enteral nutrition. Meditsinskiy Sovet. 2024;18(11):278–291. (In Russ.) https://doi.org/10.21518/ms2024-323.
24. Daĭkhes NA, Pilat TL, Burkin AV, Vinogradov VV, Reshulsky SS, Fedorova EB, Khanferyan RA. The effectiveness of specialized detoxification nutrition for cancers. P.A. Herzen Journal of Oncology. 2020;9(6):59-66. (In Russ.) https://doi.org/10.17116/onkolog2020906159.
25. Odinaeva ND, Kondratyeva EI, Pilat TL, Fatkhullina IR, Zhekaite EK, Kuznetsova YuG. Efficiency of using domestic enteral formula with metabolic action in children with cystic fibrosis. Farmateka. 2025;32(Suppl. 1):78–86. (In Russ.) https://doi.org/10.18565/pharmateca.2025.1-s1.78-86.
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For citations:
Pilat TL, Tropina EP, Zmanovskaya VA, Zhivaeva ON, Anikina VS, Kuznetsova YG, Lyapunova TV, Semin DA. Nutritional support for children with cerebral palsy: experience in the use of oedematous enteral nutrition in children. Meditsinskiy sovet = Medical Council. 2025;(11):237-247. (In Russ.) https://doi.org/10.21518/ms2025-301
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