Complications and outcomes of gastrostomy versus nasogastric tube feeding in paediatric allogeneic bone marrow transplant: A prospective cohort study

Evans, James; Green, Dan; O’Connor, Graeme; Lanigan, Julie

doi:10.1016/j.clnesp.2023.02.022

Cited by 4 publications

(10 citation statements)

References 52 publications

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“…The intensity of the transplant regimens varied between reduced- and full-intensity (myeloablation), and the transplant sources included peripheral blood stem cells, bone marrow, and cord blood. The studies included groups of PN only [ 36 ], EN with PN [ 13 , 37 , 38 , 39 , 40 ], G-tube vs. NG-tube, or no feeding tube support [ 37 , 38 , 41 ], analyzing various nutritional and post-transplant parameters. Some patients received prophylactic G-tubes [ 37 , 38 , 41 ], others had NG-tubes placed by day + 1 [ 13 , 24 , 40 , 41 ], and others primarily relied on PN when the oral caloric intake was insufficient [ 36 , 39 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…The studies included groups of PN only [ 36 ], EN with PN [ 13 , 37 , 38 , 39 , 40 ], G-tube vs. NG-tube, or no feeding tube support [ 37 , 38 , 41 ], analyzing various nutritional and post-transplant parameters. Some patients received prophylactic G-tubes [ 37 , 38 , 41 ], others had NG-tubes placed by day + 1 [ 13 , 24 , 40 , 41 ], and others primarily relied on PN when the oral caloric intake was insufficient [ 36 , 39 , 42 ]. An alteration in nutritional support regimens was found to have an impact on the ability to meet energy requirements, as well as on various post-transplant outcomes, including length of stay (LOS), engraftment, overall survival (OS), and the incidence of acute GVHD (aGVHD), infection, and veno-occlusive disease (VOD).…”

Section: Resultsmentioning

confidence: 99%

“…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 ]. Approaches to EN varied between boluses, continuous for 12–20 h, or for 9–12 h overnight to supplement daytime PO intake [ 36 , 37 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…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].…”

Section: Acute Gastrointestinal (Gi) Gvhdmentioning

confidence: 95%

“…In a study that evaluated only patients who received PN, a significant number of infections were found to occur in pediatric BMT patients, and the rates of complications correlated with the length of PN use [36]. However, no significant differences in bloodstream infection or overall infection rates were noted between the nutritional support groups in three other studies [37,41,42]. Mellgren et al observed increased febrile episodes attributed to G-tubes within the first three months post-BMT when compared to patients with NG-tubes; however, no infections were life-threatening [43].…”

Section: Infectionsmentioning

confidence: 99%

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

Murphy,

Symons,

Cooke

2024

Children

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Nutrition is vital to the long-term survival of children undergoing blood and marrow transplantation (BMT), but there is no standardization on how to optimize the nutritional status of these patients. A literature search was performed to evaluate nutritional support approaches currently in practice for pediatric patients who are undergoing BMT. CINAHL, Embase, and Cochrane databases were searched for peer-reviewed articles evaluating nutritional interventions for BMT recipients aged 20 or younger. Nine articles published between 2019 and 2023 were found and reviewed. The nutritional support varied between enteral nutrition, parenteral nutrition, a combination of both, and prophylactic feeding tube placement. The post-transplant outcomes identified as associated with alterations in nutritional regimens included length of stay, date of platelet engraftment, incidence of acute graft-versus-host disease, infection rate, and overall survival. The use of any amount of enteral nutrition compared to parenteral alone was beneficial. Complications during BMT can potentially be decreased via prioritizing enteral nutrition over parenteral. The paucity of literature on this topic highlights an unmet need in the field. Future research should focus on ways to optimize the nutritional support of transplant recipients, including increasing the likelihood of enteral feeding tube placement and utilization.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Acute Gastrointestinal (Gi) Gvhdmentioning

confidence: 95%

Section: Infectionsmentioning

confidence: 99%

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

Murphy,

Symons,

Cooke

2024

Children

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Kinder mit Knochenmarktransplantation wie enteral ernähren?

2023

Aktuelle Ernährungsmedizin

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Im Zuge einer Knochenmarktransplantation kommt es häufig zu gastrointestinalen Problemen. Insbesondere für Patienten im Kindesalter besteht das Risiko einer Mangelernährung. J. Evans et al. haben nun bei dieser Gruppe von Patienten die Effekte einer Gastrostomie vs. nasogastralen Sonde auf Komplikationen im Zusammenhang mit der Sonde, die Ernährungsoutcomes sowie klinischen Outcomes untersucht.

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One Tube Does Not Fit All: Parent Experiences and Decision-Making for Choosing a Nasogastric Tube or Gastrostomy for Their Child During Allogeneic Bone Marrow Transplant

Evans,

Lanigan,

Green

et al. 2024

Cancer Care Research Online

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Background: Children undergoing bone marrow transplant (BMT) are at risk of developing malnutrition. A feeding tube becomes a requirement for most children to meet their nutritional and medication requirements. Two tubes are typically used: nasogastric tube (NGT) or gastrostomy. At the UK center where this study took place, parents are offered a choice between these tubes. Objective: This qualitative data collection in a mixed methods study explored why parents choose either tube and their experiences of using it. Methods: Parents participated in 2 semistructured interviews. First, on admission to explore why they chose either tube. Second, 1–2 months postdischarge to explore their experience of using the tube. Interviews took place over 18 months. Transcripts were thematically analyzed. Results: Sixteen parents whose child had an NGT, 17 a gastrostomy, were interviewed. Choice was experienced across a continuum of difficulty and freedom. Many parents deferred to the expertise of professionals; others felt they were the experts in their child. Influential factors in decision-making included expected duration of need, the child’s age and activity, cosmetic differences, balancing gastrostomy surgery against NGT dislodgement, lay advice, healthcare professionals’ recommendations and prior tube feeding experiences. Conclusions: Parents valued choice appreciating 1 feeding tube might not suit every child. Implications for Practice: Choice of a gastrostomy or NGT should be offered to children prior to BMT. What is Foundational: Parents navigate a complex decision-making process when choosing a feeding tube for their child. Healthcare professionals can facilitate informed decision-making through collaborative discussions, inclusion of peer support, and provision of balanced information.

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Complications and outcomes of gastrostomy versus nasogastric tube feeding in paediatric allogeneic bone marrow transplant: A prospective cohort study

Cited by 4 publications

References 52 publications

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

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

Kinder mit Knochenmarktransplantation wie enteral ernähren?

One Tube Does Not Fit All: Parent Experiences and Decision-Making for Choosing a Nasogastric Tube or Gastrostomy for Their Child During Allogeneic Bone Marrow Transplant

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