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Intensive enteral nutrition support in paediatric bone marrow transplantation
A Langdana1, N Tully, E Molloy
1Department of Haematology and Oncology, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland.
Insights
This study shows intensive enteral feeding protocols successfully nourished 86% of pediatric bone marrow transplant (BMT) patients. Most patients maintained adequate weight, with high patient/parent satisfaction despite needing multidisciplinary support.
Area of Science:
- Pediatric Hematology/Oncology
- Gastroenterology
- Nutrition Science
Background:
- Bone marrow transplantation (BMT) in children often leads to gastrointestinal complications affecting nutritional status.
- Effective nutritional support is crucial for recovery and reducing morbidity post-BMT.
Purpose of the Study:
- To evaluate the efficacy and outcomes of an intensive enteral feeding protocol in pediatric BMT patients.
- To assess the feasibility of maintaining nutrition via nasogastric (NG) tubes during and after BMT.
Main Methods:
- Retrospective analysis of 53 pediatric BMT patients (1996-1998).
- Elective insertion of NG tubes for enteral feeding with various formula types.
- Routine use of morphine for mucositis and prompt NG tube replacement.
Main Results:
- 86% (42/49) of evaluable patients were exclusively maintained on enteral nutrition.
- Only 7 patients required parenteral nutrition.
- Most patients maintained weight, with few experiencing significant underweight post-discharge.
Conclusions:
- An intensive enteral feeding protocol is highly effective for nutritional support in pediatric BMT.
- The protocol demonstrated good patient tolerance and outcomes, with high satisfaction.
- Multidisciplinary support is essential for the successful implementation of such feeding protocols.
Abstract:
This study retrospectively analyses the experience with an intensive enteral feeding protocol in children undergoing BMT at the National Paediatric BMT Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin. Fifty-three patients were transplanted between January 1996 and December 1998; 42 patients received allogeneic transplants, (19 unrelated) and 11 were autologous. Indications included ALL (21), ANLL (3), CML (3), JCML (1), MPS (5), WAS (2), AA/FA (6), NHL/HD (3) and solid tumours (9). Nasogastric (NG) tubes were inserted electively either during conditioning or within the first week when voluntary oral intake had decreased. Nineteen patients were commenced on a whole protein-based formula, 28 on a semi-elemental preparation and two were commenced on an elemental feed. All were maintained on an elemental formula during the period of maximal gut toxicity. Tubes which were vomited were promptly replaced and morphine infusions were routinely employed until mucositis had resolved. Of 49 evaluable patients, 42 (86%) were maintained exclusively on enteral nutrition and seven required parenteral nutrition. Seven patients weighed <85% ideal body weight (IBW) at discharge (range 75-84), only one of whom was <85% IBW at 3 months. Twenty-two patients continued on NG feeds following discharge (median 41 days). No patient had veno-occlusive disease. The programme was overwhelmingly endorsed by patients and/or parents but required intensive multidisciplinary counselling to ensure success.