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Nutritional Support: Enteral Nutrition Pathway for Children Undergoing Hematopoietic Stem Cell Transplantation
Temima Oratz1, Caitlin Bate1, Alyssa Smith2
1Children's Healthcare of Atlanta.
Insights
Implementing enteral nutrition (EN) support for children undergoing hematopoietic stem cell transplantation (HSCT) showed it was safe but faced feasibility challenges with tube placement and maintenance.
Area of Science:
- Pediatric Hematology
- Gastroenterology
- Transplantation Medicine
Background:
- Children undergoing hematopoietic stem cell transplantation (HSCT) face a high risk of malnutrition.
- Enteral nutrition (EN) support can mitigate malnutrition in these pediatric patients.
Purpose of the Study:
- To assess the safety and feasibility of a new EN pathway for pediatric HSCT patients.
- To compare EN and parenteral nutrition (PN) utilization before and after pathway implementation.
Main Methods:
- An evidence-based, standardized EN pathway was introduced for pediatric HSCT recipients.
- Statistical analyses, including t tests and chi-square tests, compared nutrition support rates pre- and postimplementation.
Main Results:
- A greater proportion of patients received EN postimplementation, with an increase in average EN days (8.3 vs. 5.3 days).
- While clinically significant, the increase in EN use was not statistically significant.
- Fifteen patients required both EN and PN postimplementation.
- The EN pathway demonstrated safety but faced feasibility issues, primarily related to nasojejunal tube placement and maintenance.
Conclusions:
- The implemented EN pathway is safe for pediatric HSCT patients.
- Challenges in nasojejunal tube management limited the pathway's overall feasibility.
- Further refinement is needed to optimize EN delivery in this vulnerable population.
Background:
Children undergoing a hematopoietic stem cell transplantation (HSCT) are at a higher risk for malnutrition, which could be reduced by enteral nutrition (EN) support.
Objectives:
This study evaluated the safety and feasibility of implementing an EN pathway for children undergoing HSCT.
Methods:
An evidence-based, standardized EN pathway was implemented for children undergoing HSCT. Parenteral nutrition and EN rates were compared among patients pre- and postimplementation, and t tests and chi-square tests were performed.
Findings:
A larger proportion of patients received EN and had an increased number of EN days (8.3 versus 5.3 days) postimplementation, which was clinically significant but not statistically significant. Postimplementation, 15 patients required EN and parenteral nutrition. The EN pathway was safe, but had limited feasibility because of the difficulty of placing and maintaining the nasojejunal tube.
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