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Cyclic parenteral nutrition during bone marrow transplantation in children
Insights
Cyclic parenteral nutrition effectively supports pediatric patients during intensive cancer therapy, offering an infusion-free period for other treatments. Prealbumin levels reliably indicate patient status, unlike other nutritional markers.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Hematology
Background:
- Bone marrow transplantation (BMT) for pediatric malignancies requires intensive therapy.
- Nutritional support is critical during BMT, often necessitating parenteral nutrition.
- Cyclic administration of parenteral nutrition may offer practical advantages.
Purpose of the Study:
- To evaluate the efficacy and practicality of cyclic parenteral alimentation in children undergoing BMT.
- To assess nutritional status using various markers during cyclic parenteral nutrition.
- To determine the reliability of different nutritional markers in reflecting clinical status.
Main Methods:
- Nine children received cyclic parenteral nutrition (18 hours/day) for an average of 29 days post-BMT.
- Caloric and nitrogen intake were quantified.
- Nutritional status was assessed via nitrogen balance, creatinine-height index, serum albumin, transferrin, and prealbumin.
- Liver function, blood glucose, electrolytes, and osmolality were monitored.
Main Results:
- Cyclic parenteral nutrition provided adequate caloric (55.9 kcal/kg/day) and nitrogen (0.28 g/kg/day) intake.
- Minimal, transient elevations in liver function tests were observed.
- Prealbumin levels accurately correlated with clinical status changes.
- Nitrogen balance, creatinine-height index, albumin, and transferrin did not consistently parallel clinical status.
Conclusions:
- Cyclic parenteral alimentation is a feasible method for nutritional support in pediatric BMT patients.
- It allows for an infusion-free period, facilitating drug and blood administration.
- Prealbumin is a reliable and easily determined marker for assessing nutritional status and clinical changes in these patients.
Abstract:
Nine children underwent ten bone marrow transplants for malignancies and were supported by parenteral alimentation administered in cyclic fashion 18 hours daily. Children received cyclic parenteral nutrition for an average of 29 days, which provided a caloric intake (mean +/- SD) of 55.9 +/- 18.1 Kcal/kg/day, and a nitrogen intake of 0.28 +/- 0.08 g/kg/day. Nutritional status was assessed using nitrogen balance, creatinine-height index, and visceral protein concentrations including serum albumin, transferrin, and prealbumin. Minimal transient elevation in tests of liver function were observed without marked derangement in blood glucose, electrolytes, or osmolality. Unlike prealbumin, determinations of nitrogen balance, creatinine-height index, serum albumin and transferrin concentrations did not parallel changes in clinical status. Cyclic parenteral alimentation is a practical approach to the maintenance of nutrition during intensive antitumor therapy and provides an infusion-free period for the administration of drugs and blood transfusions without interfering with nutritional support. Prealbumin accurately reflects changes in the patient's clinical status at any point and is easily and reliably determined.