Prevalence, Clinical Presentation and Factors Associated With Chronic Respiratory Disease Among Children With Cerebral Palsy at Kenyatta National Hospital - a Hospital Based Cross-sectional Study.

Abstract

Background: Respiratory complications are the major causes of morbidity and repeated hospitalizations in children with cerebral palsy (CP). These children have risk factors related to their neurological impairment and muscle weakness, predisposing them to respiratory complications. Identifying the magnitude and clinical presentation of chronic respiratory disease among these children will be valuable to inform guidelines on optimization of their management. Study objectives: To determine the prevalence, clinical presentation and factors associated with chronic respiratory disease among children with CP receiving care at Kenyatta National Hospital (KNH). Method: A hospital based cross-sectional study caried out at the KNH, on children with CP, enrolled from inpatient, gastroenterology, neurology and occupational therapy clinics. Caregivers were interviewed and children examined to obtain relevant sociodemographic and clinical information, and data was captured on a paper case record form. A consecutive sampling technique was used to reach sample size of 103. Key outcomes of interest were chronic respiratory signs and symptoms, and sociodemographic and clinical risk factors. Prevalence of chronic respiratory disease was computed for chronic lung disease and chronic upper airway disease. Logistic regression was conducted to evaluate factors associated with chronic respiratory disease. Results: 103 participants were enrolled, male participants were 54.4%, median age was 3years, 22% had severe CP, 53.4 had chronic seizures %, 12.5% had severe swallowing incoordination, 55.3% coughed during meals and 10.0% had severe malnutrition. Chronic respiratory symptoms were as follows - chronic cough in 28.2%, chest congestion in 27.2%, wheeze in 16.5%. 42.7% had snoring and 7.8% had sleep apnoea. Abnormal respiratory signs included resting SPO2 below 95% in 29%, finger x clubbing in 17.5%, chest wall indrawing in 17.5%, chest rattles in 6.8%, nasal flaring in 36.9%, stridor in 6.8% and grunting in 6.8%. The prevalence of chronic lung disease was 21%, of chronic upper airway disease was 42.7%. Combined prevalence of any type of chronic respiratory disease was 55% (95% CI 45%, 65%). Univariate analysis revealed CRD was associated with male sex (OR 2.23, p=0.04) and swallowing incoordination (OR 4.0, p=0.01), and adjusted analysis revealed that swallowing incoordination remained independently associated with chronic respiratory disease (OR 3.8, p=0.02). Conclusions and Recommendations: The prevalence of chronic respiratory disease among children with cerebral palsy was high. Commonest clinical presentation was cough, congested chest and snoring, and swallowing incoordination was an independent risk factors in this study population. We recommend routine screening of children with cerebral palsy for chronic respiratory disease and their linkage into specialized care for the same