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Total parenteral nutrition in bone marrow transplant: what is the appropriate energy level?
M L Forchielli1, N Azzi, S Cadranel
1Department of Pediatrics, Medical School, Bologna, Italy. l.for@med.unibo.it
Insights
Total parenteral nutrition (TPN) in bone-marrow transplant (BMT) patients provided less energy than prescribed, impacting recovery. Caloric intake requires careful adjustment during TPN and feeding resumption for better outcomes in pediatric BMT.
Area of Science:
- Pediatric Hematology/Oncology
- Clinical Nutrition
- Transplantation Medicine
Background:
- Total parenteral nutrition (TPN) is crucial for pediatric bone-marrow transplant (BMT) patients but is often interrupted due to complications.
- Understanding the precise energy and protein delivery during TPN is vital for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the actual energy and protein intake in children undergoing BMT receiving TPN.
- To assess the short-term effects of TPN on weight, engraftment, and complications in this population.
Main Methods:
- Retrospective analysis of 20 pediatric BMT patients (allogeneic and autologous).
- Evaluation of energy/protein intake, weight changes, engraftment time, TPN duration, complications, and metabolic abnormalities.
- Calculation of basal-metabolic rate (BMR) and nonprotein calories to nitrogen ratio.
Main Results:
- Patients received approximately 72% of prescribed calories, averaging 0.87 kcal/BMR and 1.14 g protein/kg/day.
- Body weight improved during TPN but declined afterward; engraftment occurred in 20 days.
- Caloric intake correlated with time to engraftment (p=0.002); infections and graft-versus-host disease were observed.
Conclusions:
- TPN in pediatric BMT patients delivers less energy than planned, approximating BMR with varied clinical effects.
- Caloric intake during TPN needs precise calibration and adjustment upon feeding resumption to enhance recovery.
- Further research into optimal TPN strategies is warranted to improve outcomes in pediatric BMT.
Objectives:
Total parenteral nutrition (TPN), recommended during bone-marrow transplant (BMT), is often withheld following complications. We aim to determine the effective amount of energy supplied and its short-term effects in children requiring BMT.
Methods:
Twenty children (11 males, 9 females, mean age 8 years, range 1-18 years) receiving 13 allogenic and 7 autologous BMT for malignant (13) and nonmalignant (7) diseases, were retrospectively evaluated for energy/protein intakes, weight changes, time to engraftment and on TPN, occurrence of complications, and metabolic abnormalities.
Results:
Each child received approximately 72% of the prescribed calories, an average of 0.87 +/- 0.2 x basal-metabolic rate, 1.14 +/- 0.4 g protein/kg/day, and 176 +/- 34:1 nonprotein calories:nitrogen ratio. Body weight improved during the 35 days (range 14-62) of TPN, with loss thereafter. Engraftment occurred in 20 +/- 7.5 days. Caloric intake and time to engraftment were related (p = 0.002). Ten central-venous-line and 12 gastrointestinal infections occurred. Among laboratory abnormalities, liver function tests resulted temporarily altered in 10 patients, and permanently in 1 child with cholestasis. Eight children developed graft-versus-host disease. Five died of cancer.
Conclusions:
The energy supplied with TPN in BMT is less than expected and approximately covers the BMR with mixed effects. Energy intake needs to be calibrated during TPN and adjusted during feeding resumption to expedite recovery.