Nutritional status and functions in children with cerebral palsy at different gestational ages.

IMPORTANCE: Malnutrition is highly prevalent in children with cerebral palsy (CP) and adversely affects rehabilitation outcomes. Preterm birth is a major risk factor for CP, yet the relationship between functional status and malnutrition in preterm children with CP remains unclear. OBJECTIVE: To investigate the effect of gestational age on the association between nutritional status and function levels in children with CP. METHODS: This study included 575 children with CP enrolled between July 2020 and December 2021. Participants were stratified into four groups by gestational age at birth: <28, 28-32, 33-36, and ≥37 weeks. Nutritional status was assessed using weight-for-age, weight-for-height, height-for-age, and body mass index-for-age z-scores. Gross motor function, eating/drinking ability, and activities of daily living (ADL) were evaluated using Gross Motor Function Classification System (GMFCS), Eating And Drinking Ability Classification System (EDACS), and ADL scales, respectively. RESULTS: Of the 575 children, 49.0% were born preterm, and 40.4% were categorized as malnutrition. Nutritional status was significantly correlated with gestational age (Kendall's Tau-b = 0.13, P < 0.01) and all functional measures (P < 0.01). Gestational age was correlated with ADL level (Kendall's Tau-b = 0.11, P < 0.01). Stratified analyses revealed significant correlations between nutritional status and GMFCS, EDACS, and ADL levels in both the 28-32-week and ≥37-week groups (all P < 0.01). Multinomial logistic regression analysis further demonstrated that gestational age <32 weeks was independently associated with moderate undernutrition (<28 weeks: OR: 4.61, 95% CI: 1.83-11.63, P = 0.001; 28-32 weeks: OR: 2.71, 95% CI: 1.56-4.72, P < 0.001). INTERPRETATION: Nutritional status in preterm children with CP, particularly those born before 32 weeks of gestation, correlates significantly with motor function, feeding ability, and daily living skills. These findings may inform the development of individualized rehabilitation strategies for this high-risk population.