Enteral nutritional therapy practices in pediatric hematopoietic stem cell transplant centers in Brazil

The aim of this study was to analyze the use of enteral nutritional therapy in pediatric hematopoietic stem cell transplantation centers in Brazil, addressing its application, challenges, and current practices.

This cross-sectional study was conducted from May to October 2023 in Brazilian pediatric hematopoietic stem cell transplantation centers. Data were collected via a structured questionnaire sent to eligible centers, covering the use of prophylactic nasoenteral tubes, formula selection, and adaptations for gastrointestinal symptoms.

Seventeen transplant centers participated, predominantly located in the Southeastern region (6.91%). Among them, 82.4% routinely used prophylactic nasoenteral tubes, with polymeric formulas being the first choice in 82.4% of cases. Normocaloric formulas (0.9-1.2 kcal/mL) were also widely adopted (82.4%). For managing gastrointestinal symptoms, the most common approach was reducing the diet volume (30.6%). This study identified a gap in specialized formulas for children aged 10 to 18 years, with 47.1% of centers opting for formulas designed for adults in this age group due to a lack of alternatives.

The study highlights regional disparities in hematopoietic stem cell transplantation services in Brazil and confirms enteral nutritional therapy as the primary nutritional support in pediatric transplantations. It also reveals the absence of consensus regarding the best formulas and management protocols, particularly for the 10- to 18-year age group. The findings point to an urgent need for further research and the development of standardized guidelines to ensure safe and effective nutritional support, improving transplant outcomes, and promoting proper growth and development in these patients.