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[Autologous bone marrow transplantation in children. Use of parenteral nutrition]
A Garaventa1, E Lanino, G Dini
1IV Divisione Pediatria, Istituto Giannina Gaslini, Genova, Italia.
Insights
Children undergoing autologous bone marrow transplantation (ABMT) often require parenteral nutrition (PN) due to severe gastrointestinal toxicity. This study found PN effectively improved body weight in pediatric cancer patients without significant complications.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Hematology
Context:
- Autologous bone marrow transplantation (ABMT) involves intensive chemotherapy and irradiation.
- Pediatric cancer patients undergoing ABMT frequently experience severe gastrointestinal toxicity and anorexia.
- This necessitates the use of Parenteral Nutrition (PN) for nutritional support.
Purpose:
- To evaluate the efficacy and safety of Parenteral Nutrition (PN) in pediatric cancer patients undergoing autologous bone marrow transplantation (ABMT).
- To assess nutritional status changes and identify potential complications associated with PN in this patient population.
Summary:
- This study analyzed 37 courses of PN in 35 pediatric cancer patients (age 8 months-17 years) post-ABMT.
- Patients received PN for 10-64 days, with nutritional assessments including body weight and serum proteins.
- A significant increase in mean percent ideal body weight was observed (95.8% to 98.5%, p<0.0005).
- No major metabolic complications or electrolyte imbalances occurred, except for hypokalemia in 5 patients receiving Amphotericin B.
Impact:
- Parenteral Nutrition (PN) is a safe and effective supportive therapy for pediatric cancer patients undergoing autologous bone marrow transplantation (ABMT).
- PN contributes to improved nutritional status, specifically weight gain, in this vulnerable patient group.
- Findings support the continued use of PN for managing treatment-induced malnutrition in pediatric oncology.
Abstract:
Children undergoing ABMT, a procedure which entails massive doses of chemotherapy along with total-body irradiation, are candidate to develop severe gastrointestinal toxicity and prolonged anorexia requiring administration of Parenteral Nutrition (PN) for variable periods. We report a series of 35 consecutive children affected by malignancies who underwent 37 courses of PN after ablative therapy followed by ABMT. Age ranged from 8 months to 17 years; 16 were females, 19 males. There were 23 cases of neuroblastoma, 5 of Wilms' tumor, 3 of acute myelogenous leukemia, 2 of Ewing's sarcoma, 1 case each of rhabdomyosarcoma and acute lymphoblastic leukemia. All patients developed severe neutropenia for 9-42 days (median 18 d). Fever occurred in all patients; sepsis was documented in 10. Duration of PN ranged from 10 to 64 days (23 +/- 9; mean +/- SD). PN solution, containing crystalline L-Aminoacids (8.5%) mixed with 33% glucose, minerals, trace elements and vitamins provided for children a caloric intake of 49.8 +/- 17.3 Kcal/Kg/day with a nitrogen intake of 0.26 +/- 0.27 g/Kg/day. Nutritional assessment, utilizing percent ideal body weight, serum protein electrophoresis, C3, pseudocholinesterase and fibrinogen, was performed at the beginning and at the completion of each course of PN. Mean percent ideal body weight was 95.8 before PN, 98.5 on last day of PN (p less than 0.0005). Other parameters did not change significantly. No metabolic complication nor severe electrolyte imbalance were observed except for 5 patients who developed hypokalemia in coincidence with administration of Amphotericin B.(ABSTRACT TRUNCATED AT 250 WORDS)