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Enteral nutrition optimization program for children undergoing blood & marrow transplantation: A quality improvement
Jessica D Murphy1, Kenneth R Cooke2, Heather J Symons2
1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, USA.
Insights
A novel enteral nutrition optimization program for pediatric blood and marrow transplantation (BMT) patients showed high feasibility and acceptance among providers. While clinical outcomes did not significantly improve, the program shifted culture towards optimizing nutrition support.
Area of Science:
- Pediatric Hematology/Oncology
- Transplantation Medicine
- Clinical Nutrition
Background:
- Malnutrition is a significant risk factor for morbidity and mortality in pediatric patients undergoing blood and marrow transplantation (BMT).
- Optimizing enteral nutrition support is a potential strategy to improve clinical outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate a novel program designed to optimize enteral nutrition support in pediatric BMT patients.
- To assess the feasibility and acceptance of this nutrition optimization program among clinical providers.
Main Methods:
- A Quality Improvement project employing a pre-post-intervention design and post-intervention surveys.
- Evaluation of biometric indicators, complications, and post-transplant milestones in patients aged 0-18 receiving the intervention.
- Statistical analysis using Mann-Whitney U, Fisher's exact, and Chi-square tests; provider feedback collected via survey.
Main Results:
- No statistically significant differences were observed in weight loss, malnutrition rates, graft-versus-host-disease incidence, time to engraftment, infection rates, or length of stay between groups.
- The intervention demonstrated high feasibility and acceptance, with 88.9% of 45 participating providers agreeing or strongly agreeing.
- Increased utilization of nasogastric and gastrostomy tubes was noted post-intervention.
Conclusions:
- The novel enteral nutrition optimization program was highly feasible and accepted by clinical providers, fostering a culture shift towards prioritizing enteral nutrition.
- Despite high acceptance, the study was limited by a small sample size, precluding definitive conclusions on clinical significance.
- Further research is warranted to elucidate the clinical impact of this nutrition support program in pediatric BMT.
Background:
Malnutrition in children and young adults undergoing blood and marrow transplantation (BMT) increases morbidity and mortality. Addressing this via optimization of enteral nutrition can potentially improve outcomes.
Methods:
This Quality Improvement project utilized pre-post-intervention design and post-intervention survey to evaluate a novel program optimizing enteral nutrition support in children undergoing BMT. All patients aged 0-18 who were admitted during the 16-week implementation period followed the Enteral Nutrition Optimization Program from pre-BMT through discharge. Data on biometric indicators, complications, and post-transplant milestone time markers were evaluated via Mann-Whitney U, Fisher's exact, and Chi-square tests as indicated using SPSS™ Version 27. A separate sample of clinical providers completed a post-intervention survey to evaluate the feasibility and acceptance of the intervention.
Findings:
Six patients received the intervention, with 12 patients evaluated. There were no statistical differences between groups on measured evaluations of weight loss (0.15 kg vs +0.4 kg, p = 0.39), malnutrition (2 vs 3, p = 0.545), graft-versus-host-disease (2 vs 2, p = 1), time to engraftment (platelets day 22 vs 20.5, p = 0.589), infections (p = 0.368), and length of stay (32.5 days vs 31 days, p = 1). The provider sample of 45 participants showed overall feasibility and acceptance of the intervention (88.9% agreed or strongly agreed).
Discussion:
Feasibility and acceptance were high, resulting in increased use of nasogastric and gastrostomy tubes. Though no clinical significance, interpretation is limited due to the small sample size.
Practice Implications:
Implementing a novel nutritional support program resulted in a culture shift towards enteral nutrition optimization. Further studies are needed to determine clinical impacts.
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