Non-ambulatory Status and Risk of Severe Vitamin D Deficiency in Children with Cerebral Palsy: A Systematic Review and Meta-analysis
Neel Parikh1, Meet Kachhadia2, Bharat Parmar3, Aishwarya Koppanatham4, Anis Shaikh5, Neha Parmar6
1Department of Neurology, Zydus Medical College and Hospital, 2Department of Neurology, Florida Atlantic University Charles E. Schmidt College Of Medicine, Florida, USA, 3Department of Pediatrics, Zydus Medical College and Hospital, Dahod, 4Andhra Medical College, 5Department of Community Medicine, Zydus Medical College and Hospital Dahod, 6Zydus Medical College and Hospital India
Objective:
The aim of this meta-analysis is to estimate the increased risk of Vitamin D Deficiency (VDD) associated with non-ambulatory status (Gross Motor Function Classification System [GMFCS] Levels IV-V) compared to ambulatory status (GMFCS Levels I-III) to estimate evidence-based screening protocols.
Background:
Vitamin D deficiency significantly compromises bone health and motor function in Cerebral Palsy (CP), yet a unified risk quantification for the most severely affected children has been lacking. Establishing this quantification is essential to guide standardized screening practices.
Design/Methods:
We conducted a random-effects meta-analysis of observational studies that reported serum 25(OH)D levels and GMFCS classification in children with cerebral palsy aged 0-18 years. Vitamin D deficiency was typically defined using 25(OH)D cutoffs below 20 ng/ml. Six studies (N=676 CP patients) were included, with four contributing 2×2 count data for the primary analysis. The Risk of bias was evaluated using Newcastle-Ottawa Scale (NOS).
Results:
The pooled analysis demonstrated a strong and consistent association between severe motor impairment and VDD risk. Non-ambulatory children (GMFCS IV-V) had 2.62 times greater odds of Vitamin D deficiency compared to those who were ambulatory (OR = 2.62; 95% CI : 1.38, 4.98). We observed considerable variability across the studies (I²= 59.8%). A Sensitivity analysis excluding one outlier study confirmed that the association remained significant (OR of 3.21; 95% CI : 1.87, 5.51) with lower heterogeneity (I² = 44.9%). The median Newcastle-Ottawa Scale score was 6 of 9, indicating moderate risk of bias.
Conclusions:
Non-ambulatory status (GMFCS IV-V) is a major risk factor for vitamin D deficiency in children with cerebral palsy. These findings highlight the need to include routine vitamin D screening and prophylactic supplementation in non-ambulatory pediatric CP care.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.