The relationship between functional status and hematological parameters in children with spastic cerebral palsy: a retrospective cross-sectional study.

Background: Muscle spasms, joint stiffness, dysphagia, dystrophy, and other problems associated with cerebral palsy (CP) might lead to abnormalities in some hematological parameters, yet the characteristics of common hematological parameters in children with spastic CP and the relationship between abnormality of hematological parameters and functional status in those children are unclear. This study seeks to address these concerns, thereby providing guidance for healthcare professionals in selecting appropriate hematological monitoring indicators for the effective management of children with CP.

Methods: Children with spastic CP aged from 2 to 18 years (y) were included between 2016 and 2023. Information such as sex, age, type of CP, and Gross Motor Function Classification System (GMFCS) level was recorded in a purpose-built database. The results of hematological examinations were collected, calculated and compared among different GMFCS levels and spastic CP subtypes. The relationships between hematological parameters and GMFCS levels and spastic CP subtypes were also conducted using multiple linear regression models, with and without adjustment for participants' characteristics and hematological parameters that affect blood lactate. The study was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) under ChiCTR2000033800.

Results: A total of 770 children [516 males, 254 females; mean age (standard deviation): 4.55 (2.83) y] with spastic CP were enrolled for analysis. Most participants belonged to ambulant children of GMFCS level I-III, and the common subtypes were diplegia and hemiplegia. No significant difference in the levels of blood routine tests, coagulation indicators, electrolytes, liver and renal function indices was observed among different GMFCS levels and subtypes. There were significant differences in the blood lactate concentrations among different GMFCS levels (level I vs. level IV in 2-3 y children, P=0.006; level I vs. levels IV-V in 4-6 y children, P=0.01) and among different subtypes (hemiplegic vs. quadriplegic: P=0.001 in 2-3 y children, P=0.02 in 4-6 y children). Multiple linear regression analyses revealed the association between blood lactate concentrations and GMFCS in 2-3 y children. Compared with GMFCS I, children with GMFCS IV had higher concentrations of blood lactate [b=0.614, 95% confidence interval (CI): 0.173, 1.055 from a linear regression model with adjustment for spastic CP subtype, age and sex; b=0.428, 95% CI: 0.009, 0.846 with additional adjustment for hematological parameters that affect blood lactate].

Conclusions: Increased blood lactate concentrations are commonly observed in children with spastic CP. Abnormality of blood lactate concentration is correlated with GMFCS in 2-3 y children with spastic CP. The lactate shall be given strengthened monitoring during the management of children with CP, and the investigation of the potential association between functional status and hematological parameters in children with CP requires further original studies.