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Enteral nutrition: a first option for nutritional support of children following allo-SCT?

S Azarnoush1, B Bruno, L Beghin

  • 1Hématologie pédiatrique, Hôpital Jeanne de Flandre, Univ Lille Nord de France, Lille, France.

Bone Marrow Transplantation
|January 11, 2012
PubMed

Insights

Early enteral nutrition (EN) may be a viable option for pediatric patients undergoing myeloablative conditioning allogeneic stem cell transplant (MAC allo-SCT). Parenteral nutrition (PN) should be reserved as a rescue therapy, potentially combined with EN.

Area of Science:

  • Pediatric Hematology/Oncology
  • Gastroenterology
  • Transplant Medicine

Background:

  • Parenteral nutrition (PN) is standard for nutritional support in pediatric patients undergoing myeloablative conditioning allogeneic stem cell transplant (MAC allo-SCT).
  • Early enteral nutrition (EN) has not been extensively studied in this vulnerable population.

Purpose of the Study:

  • To prospectively assess the outcomes of early EN initiation in children undergoing MAC allo-SCT.
  • To compare outcomes between patients receiving EN alone versus those requiring supplemental PN.

Main Methods:

  • A prospective study of 65 children undergoing MAC allo-SCT from 2003-2010.
  • Patients initiated EN on day 1 post-transplant.
  • Outcomes were compared between an EN-only group (n=50) and an EN-PN group (n=15).

Main Results:

  • The EN-only group demonstrated significantly shorter time to platelet recovery (P=0.01) and reduced hospital length of stay (P<0.001).
  • The EN-PN group had a higher proportion of unrelated donors (P=0.02) and increased severe acute graft-versus-host disease (aGVHD; P=0.004).
  • PN was initiated 14 days post-transplant due to poor tolerance or severe gut aGVHD; BMI Z-score declined in the EN-PN group (P=0.02).

Conclusions:

  • Early EN may be a suitable nutritional support strategy for pediatric MAC allo-SCT patients.
  • PN should be considered a rescue option, potentially used adjunctively with EN.
  • Only 23% of patients required PN, often not for critical illness.

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