A retrospective case–control study of gastrostomy use in children undergoing hematopoietic cell transplantation

Abstract

Background Maintaining a good nutritional status during the hematopoietic cell transplantation (HCT) procedure is challenging in the pediatric population. Methods In a multicentric retrospective study, we compared the outcome of nutritional status and HCT‐related parameters in 227 pediatric patients during and after HCT between 2005 and 2015. 112 patients received a gastrostomy before the start of HCT (GS group), and 115 did not receive a gastrostomy (NGS). Data collection was performed at HCT, 3, 6, and 12 months post‐HCT. Results At time point of HCT the Standard Deviation Score (SDS) of weight was 0.17 in the NGS group, and 0.71 in the GS group (p = .01) Patients in the NGS group lost more weight during the first 3 months after HCT than patients in the GS group. At 12 months, patients in the NGS remained at a lower weight, while patients in the GS group slightly increased their weight. There were no differences between the groups in the incidence of acute graft‐versus‐host‐disease (GvHD), overall survival, and non‐relapse mortality. However, the number of febrile episodes requiring intravenous treatment with antibiotics, was higher in the GS group as compared to the NGS group, during the first 3 months post‐HCT (p < .001). Conclusions Our results indicate that gastrostomy can be utilized in children undergoing HCT without any negative effects on mortality. Therefore, the use of a gastrostomy appears to be a safe option to maintain a good nutritional status during the HCT procedure.

Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review

“…The studies varied with respect to when nutritional support was introduced, as well as the means to measure the ongoing nutritional status of the patients. Various ways to measure the overall nutritional status included food weighing and recording daily intake [ 37 ], daily weights [ 13 , 36 , 37 , 38 , 39 , 43 ], and the albumin level [ 13 , 36 , 37 ]. EN was typically started when patients were unable to meet more than 50% of their caloric needs over 2–3 days; however, some calculated this by the Holliday–Segar formula [ 41 ] and others by the Scientific Advisory Committee on Nutrition’s recommendations [ 37 ].…”

“…PN was added in cases of severe mucositis, GI GVHD, NG-tube refusal, or intractable vomiting and/or diarrhea [ 13 , 36 , 37 , 41 ], or otherwise in cases of an inability to meet greater than 50% of their caloric needs by EN support [ 37 ]. In studies that utilized prophylactic G-tube placement, one study found that, on average, the surgery occurred around 46 days prior to BMT admission [ 43 ], but in others, this timing was not noted [ 37 , 38 , 39 , 41 ]. When noted, NG-tubes were placed from day − 2 to day + 2 [ 40 ].…”

“…When noted, NG-tubes were placed from day − 2 to day + 2 [ 40 ]. Several studies did not explain the measures used to evaluate nutritional status or detail the specific indications for utilizing EN or PN support [ 13 , 36 , 38 , 39 , 42 , 43 ].…”

“…In one study, earlier platelet engraftment was seen in the group receiving supplemental PN to a count of >20 × 10 9 /L, but this difference was not significant at a threshold of >50 × 10 9 /L [ 40 ], whereas another study found no impact of supplemental nutrition on count recovery [ 38 ]. Although neutrophil engraftment occurred earlier in a group of patients with prophylactically placed G-tubes versus those with NG-tubes in one study [ 43 ], two other studies did not find a difference [ 38 , 40 ].…”

“…Acute gastrointestinal (GI) GVHD was found to be less frequent when supplemental EN was employed as much as possible over PN use, in one study [42]. By contrast, there were no statistically significant differences in aGVHD between the EN group and the PN groups in the Zama et al [40] nor between the G-tube and NG-tube or non-feeding tube groups in other studies [37,38,41,43]. GVHD rates as high as 33% in patients were found in a study that primarily utilized PN support when optimal oral intake could not be achieved, but no association was made between the nutritional support type and the GVHD diagnosis [39].…”