Daytime-restricted parenteral feeding is associated with earlier oral intake in children following stem cell transplant

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

“…By contrast, EN use in combination with PN contributed to improved patient outcomes in other studies, highlighting the potential benefits of continuing EN at any volume possible to maintain a diverse gut microbiota [ 22 , 50 , 51 ]. NG tube placement is usually performed by day + 1 [ 43 , 52 ]; however, in centers using post-transplant cyclophosphamide, this may be pushed to day + 5 [ 53 ]. Some studies turned to prophylactic surgical G-tube placement to help increase the utilization of EN [ 38 , 41 , 43 ], while others only administered PN during the nighttime, resulting in increased EN intake during the daytime [ 54 ].…”

Circadian immunity from bench to bedside: a practical guide

“…To this end, studies looking to apply circadian medicine should be designed and powered whenever possible to assess clinically important endpoints in addition to biomarkers. For example, one recent chronotherapy trial examined the administration of total parenteral nutrition in pediatric bone marrow transplant recipients, comparing 20-to 24-hour-a-day feeding (the current standard of care) with daytime-restricted feeding (146). Time-restricted feeding is a nutrition strategy in which caloric intake is limited to a period of 10-12 hours.…”

“…The rationale for the trial was to test whether a feeding strategy consonant with normal circadian rhythms would be beneficial in humans. They found that daytime-restricted feeding was associated with a faster transition to an oral diet and a shorter hospital stay (146). reasonably be targeted to provide a treatment in standard clinical practice (targeting, say, a single hour of the day), achieving a benefit from biological rhythms is infeasible short of an automated implant (like an insulin pump).…”

Feeding critically ill patients at the right time of day

“…Intermittent enteral feeding (providing feeds at 3 or 4 discreet times with a feeding pump during the day mimicking normal meals) and daytime cycles of parenteral nutrition (cycles that start and end during the day) are likely more physiologic. A recent pilot trial in pediatric hematopoietic stem cell transplant recipients showed that daytime infusion of parenteral nutrition is feasible and safe and is associated with a faster transition to an oral diet compared to 24-h continuous infusion [ 12 ]. Another pilot study showed that transitioning from overnight to daytime parenteral nutrition in patients with short bowel syndrome on home nutrition support is safe and not associated with dysglycemia [ 13 ].…”

“…Concern of dysglycemia is generally unfounded by empirical evidence. Recent pilot data suggests tighter daily glucose averages with daytime parenteral nutrition compared to 24-h continuous infusions [ 12 ]. It has also been hypothesized that overnight infusions may promote appetite.…”