Background: Children with cerebral palsy (CP) are prone to urinary tract infection (UTI), a common cause of childhood morbidity and mortality. However, there has been no report regarding the prevalence of UTI among this group of children inNigeria. Objectives: The study aims at determining the prevalence and the possible predictors of UTI in children with CP compared to age and sex matched children without CP. Methods: A prospective cross-sectional study was carried out among consecutive children with CP at the Neurologic Clinic in the Paediatric Department of the Federal Medical Centre, Makurdi, Nigeria, from December 2011 to May 2013. Results: The age range of the studied population was between 2 and 15 years with a mean age of 8.63 ± 3.83 years including 30 males and 22 females. UTI was confirmed in 20 (38.5%) children with cerebral palsy compared to 2 children (3.8%) without CP (p value 0.000). Among children with CP, Escherichia coli was the commonest organism isolated in 9 (9/20, 45.0%), Streptococcus faecalis in 4 (20.0%), Staphylococcus aureus in 3 (15%), while both Proteus spp., and Klebsiella spp., were isolated in 2 children (10.0%) each. Escherichia coli was also found in the 2 children without CP. All the organisms were resistant to co-trimoxazole, nalidixic acid, nitrofuratoin and amoxiclav, while they were 100% sensitive to ceftriazone and the quinolones. In a univariate regression, analysis only moderate to severe gross motor dysfunction predicted the risk of UTI (OR = 54.81, 95%CI, 2.27 - 1324.00, p value 0.014). Conclusion: Efforts should be put in place to aid mobility among children with CP in order to reduce risk of UT.
A child with cerebral palsy has a difficulty in neuromotor control, a non-progressive brain lesion and an injury to the brain that occurred before it was fully matured [
Ethical approval for the study was obtained from the Hospital Research and Ethics Committee. Children were recruited into the study if the parents or caregivers had given their consent. Subjects were consecutive patients with cerebral palsy attending the Neurologic Clinic of the Paediatrics Outpatient Department (POD) of the Federal Medical Centre, Makurdi. Controls were age (to the nearest birthday) and sex matched consecutive children, who were also attending follow-up appointments at the POD having been previously admitted, treated and had recovered from ailments such as severe malaria, lower respiratory tract infections and diarrheal disease. Subjects and controls that had taken antibiotics in the preceding two weeks, those with on-going menses or one who is having vaginal/penile discharge were excluded from the study. Recruitment into the study spanned between December 2011 and May 2013. The clinical, topographical, gross motor dysfunctions and Intelligent Quotients characterizations of the subjects were done by the principal author. The Gross Motor Function Classification System (GMFCS) as previously described was employed to classify the severity of functional impairment in children with cerebral palsy [
Symptomatic bacteriuria (ASB) or asymptomatic urinary tract infection (AUTI) is defined as the quantitative growth of bacteria, greater than or equal to 105 colony forming units per millilitre urine of the same organism, on collected midstream urine specimens, in the absence of symptoms of urinary tract infection.
Symptomatic bacteriuria (SB) or symptomatic urinary tract infection (SUTI) is defined as the quantitative growth of bacteria, greater than or equal to 105 colony forming units per millilitre urine of the same organism, on collected midstream urine specimens, in the presence of one or more than one of these signs and or symptoms of urinary tract infection including fever, dysuria, gross haematuria, cloudy or smelly urine, frequency of urination and flank/back pain.
Significant proteinuria is a presence of 2+ or more protein in the urine.
Significant haematuria is a presence of 2+ or more blood in the urine.
Significant pyuria is a presence of 2+ or more leucocyte in the urine.
Significant microscopic pyuria is white blood cell (WBC) count of 10 and above per high power field (HPF).
The Statistical analysis was done using SPSS version 16. Test between dependent and independent variables was carried out using the Chi-squared test (χ2). The logistic regression model was used to determine independent predictors (demographic, signs and symptoms) of urinary tract infection. Only independent variables with p value of ˂0.1 at the bivariate analysis were considered for logistic regression. Odd ratios with 95% Confidence Intervals were used to measure the strength of the association at the statistical significance level of p ˂ 0.05.
A total of 93 children with cerebral palsy were seen within the study period but only 52 were included in the study. Twenty children did not meet the inclusion criteria. Fourteen children were lost to follow-up, and they could not return the urine specimens. Mothers were unable to obtain urine specimens in 7 children. The age range was between 2 and 15 years with a mean age of 8.63 ± 3.83 years including 30 males and 22 females with a male to female ratio of 1:0.7. With respect to the types of cerebral palsy, 19 (36.5%) had spastic hemiplegia, 16 (30.8%) had spastic diplegia, 11 (21.2%) had spastic quadriplegia, 4 (7.7%) had a mixed combination of athetosis with spastic hemiplegia and another 2 (3.8%) children with hydrocephalus had ataxic cerebral palsy. Regarding the degree of gross motor dysfunction, 30 (57.7%) had mild dysfunction including 11 (21.2%) with grade I and 19 (36.5%) with grade II. Moderate to severe motor dysfunction is seen in 22 (42.3%) including eight (15.4%) with grade 3, five (9.6%) with grade 4 and nine (17.3%) with grade 5. Among the 34 children with CP whose ages were between 6 - 11 years and for which Ziler’s Man-Drawing Quotient was determined, 9 had scores ≤ 75% (i.e. Intellectually disabled) and 15 had scores above 75% (