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Children with severe neurologic impairment comprise a diverse group from an etiological perspective. Yet despite this diversity, there are predictable commonalities in many of the comorbidities and complications they experience. As an example, a child with a history of hypoxic ischemic encephalopathy and another with a genetic disorder associated with cerebral dysgenesis each have different reasons for their presentations but will likely have in common issues such as intellectual disability, risk for seizures, risk for oromotor dysfunction and aspiration, gastrointestinal dysmotility, osteopenia. and altered muscle tone. Please see Chapter 180 for a brief introduction to etiology and comorbidities as well as review of management of common acute care issue in this population. The focus of this chapter is on chronic comorbidities.

The hospitalist who appreciates common comorbid conditions in children with severe neurologic impairment will be prepared to more fully evaluate the child admitted with an acute illness for predisposing conditions which if treated may reduce their risk of recurrent illness and hospitalization. In addition, length of hospital stay is often longer in children with severe neurologic complexity. As a result, chronic issues which may not directly relate to the admission but require attention and management are likely to surface. The range of comorbidities in children with underlying neurologic impairments is quite extensive and can encompass virtually any organ system (Table 181-1). Data relating to prevalence of specific conditions are sparse, and when available usually relate to a specific underlying condition such cerebral palsy.1 Data that delineate a broader range of associated medical conditions in children with disability do not relate specifically to children with neurologic complexity.2 Despite the range of possible comorbidities and the lack of prevalence data, a systematic approach to assessment and management can enable the care provider to feel confident in monitoring for likely complications. What follows is a review of the most common comorbid conditions clinically encountered in children with severe neurologic impairment along with guidelines to their outpatient management.

TABLE 181-1Range of Comorbid Conditions in Children with Neurologic Complexity

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