Nutritional and morbidity-mortality risk in children with cerebral palsy: Harmonisation of centers for disease control and prevention and cerebral palsy weight-for-age growth charts.

Children with cerebral palsy (CP) frequently experience growth impairment. Weight-for-age is commonly assessed using growth charts from the Centers for Disease Control and Prevention (CDC), whereas CP Growth Charts define weight thresholds associated with increased morbidity-mortality risk. This study aimed to compare and harmonise weight-for-age cutoff points from the CP Growth Charts and CDC growth charts and to examine the alignment of U.S. CP morbidity-mortality risk thresholds within the CDC weight-for-age z-score framework in a rehabilitation-centre-based cohort of Argentine children with CP. This multicenter cross-sectional study included 809 children and adolescents with CP aged 2-20 years from rehabilitation centers. Weight-for-age was expressed as z-scores using both growth references. Morbidity-mortality risk zones were defined using CP Growth Chart thresholds according to Gross Motor Function Classification System (GMFCS). For the statistical analyses Fisher's exact test, and odds ratios (OR) with 95% confidence intervals were used to evaluate associations between motor severity, nutritional status, and morbidity-mortality risk. Cutoff points were harmonised using LMS-derived z-scores. Overall, 49.6% of participants had weight-for-age z-scores below -2 according to CDC charts. 15.1% met morbidity-mortality risk criteria, predominantly among children with GMFCS V tube feed (OR 3.91; 95% CI: 2.4, 6.4; p < 0.0001). In this Argentine rehabilitation-centre cohort, CP Growth Charts morbidity-mortality risk thresholds correspond to extremely low CDC weight-for-age z-scores (approximately -4 to -5), particularly in children with severe motor impairment (GMFCS III-V). Harmonisation using LMS parameters improves cross-reference interpretation, though replication in other LMIC and high-income country settings is warranted.