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Nutritional support in children undergoing bone marrow transplantation
A Papadopoulou1, M D Williams, P J Darbyshire
1Institute of Child Health, University of Birmingham and Bone Marrow Unit, The Children's Hospital, Birmingham, UK.
Insights
Enteral tube feeding (ETF) and parenteral nutrition (PN) effectively support pediatric patients post-bone marrow transplant (BMT). ETF demonstrated a better nutritional response and fewer complications compared to PN.
Area of Science:
- Pediatric Hematology/Oncology
- Clinical Nutrition
- Transplantation Medicine
Background:
- Nutritional status is critical for pediatric patients undergoing bone marrow transplantation (BMT).
- Maintaining adequate nutrition is essential for recovery and well-being post-BMT.
Purpose of the Study:
- To compare the effectiveness of enteral tube feeding (ETF) and parenteral nutrition (PN) in supporting nutritional status and well-being in pediatric BMT patients.
- To identify potential differences in complications and outcomes between ETF and PN.
Main Methods:
- Prospective study of 39 children (mean age 8.1 years) receiving nutritional support post-BMT.
- Comparison of patients receiving ETF versus PN, with some patients transitioning between methods.
- Assessment of anthropometric indices, nutritional status, well-being, and biochemical markers.
Main Results:
- Both ETF and PN maintained nutritional status post-BMT, with no significant anthropometric deterioration.
- ETF duration correlated with improved nutritional status, while PN was linked to more frequent exocrine pancreatic insufficiency.
- Oral mucositis impacted well-being initially with PN but improved by the end of treatment.
Conclusions:
- Both enteral tube feeding and parenteral nutrition are effective for nutritional support after bone marrow transplantation.
- Enteral tube feeding, when tolerated, offers a better nutritional response and fewer complications.
- Close monitoring of trace elements and minerals is crucial for both enteral tube feeding and parenteral nutrition regimens.
Abstract:
Nutritional status and 'well-being' were compared prospectively in 39 children (mean age 8.1 years) who received nutritional support following bone marrow transplantion (BMT): 20 received enteral tube feeding (ETF; six received parenteral nutrition [PN] subsequently) and 19 with oral mucositis received PN (one received ETF subsequently). Poor nutritional status (height for age and/or weight for height and/or mid-arm circumference z-scores <-1) was present in 18 patients and was associated with a longer hospital stay (P = 0. 01). Both ETF and PN groups were comparable with respect to age, pretransplant nutritional status and conditioning regimens. No significant deterioration in anthropometric indices in either group occurred following BMT. However, significant correlations were found between the duration of ETF (and not PN) and improvements in nutritional status. Furthermore, PN was associated with more frequent exocrine pancreatic insufficiency than ETF (P = 0.001). Oral mucositis was associated with poorer 'well being' at the start of PN compared with ETF (P < 0.0001), but this was reversed by the end of PN. Bone marrow recovery, hospital stay and positive blood cultures were similar in the two groups. Hypomagnesaemia, hypophosphataemia and biochemical zinc deficiency were common in both groups but hypoalbuminaemia and biochemical selenium deficiency were worse in the PN group. In conclusion, both ETF and PN are effective in maintaining nutritional status post-BMT. When ETF is tolerated, it is associated with better nutritional response. With the existing ETF and PN regimens close monitoring of the trace element and mineral status is required.