Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Abstract

Parenteral nutrition (PN) is the treatment of choice for nutritional support of patients undergoing allo-SCT following myeloablative conditioning (MAC). Here we prospectively assessed the outcomes of early enteral nutrition (EN) in a paediatric cohort. From 2003 to 2010, all 65 consecutive children undergoing MAC allo-SCT at our referral centre began EN the day after transplantation. Post-transplant and nutritional outcomes of patients receiving only EN (EN group, n ¼ 50) were compared with those of patients requiring additional PN (EN-PN group, n ¼ 15). In the EN group time to platelet recovery (P ¼ 0.01) and length of hospitalisation (Po0.001) were shorter, while in the EN-PN group the proportion of unrelated donors (P ¼ 0.02) and the frequency of severe acute GVHD (aGVHD; P ¼ 0.004) were higher. All patients were alive at day 100. PN was started 14 days after transplant because of poor digestive tolerance to EN or severe gut aGVHD. The body mass index Z-score in the EN-PN group decreased from transplant to discharge (P ¼ 0.02). In only 23% of cases was PN required for severely ill patients. Our results suggest that EN might be considered to be an option for nutritional support in children undergoing MAC allo-SCT, while PN should be used only as a rescue option, possibly in combination with EN.

Hypoglycemia During the Temporary Interruption of Parenteral Nutrition Infusion in Pediatric Hematopoietic Stem Cell Transplantation

“…However, because of PN‐related complications (sepsis, metabolic disorder, hepatic disorder, and gut‐mucosal atrophy), 2 enteral nutrition (EN) has been proposed as the first‐choice feeding option during HSCT 2 , 3 . EN seemed safe and effective, even in children, and resulted in better outcome and lower acute GVHD incidence 2 , 13 . Thus, EN indications in medical situations need thorough discussion.…”

“…In the pediatric setting, parenteral nutrition (PN) is required with procedures such as hematopoietic stem cell transplantation (HSCT) 1 . With initiation of the preparative conditioning regimen for HSCT, many patients develop anorexia, nausea, and mucosal injury, 2 thus necessitating PN 2 , 3 . Although these side effects improve within several weeks, a long period of PN support may be required if complications such as gastrointestinal graft‐vs‐host disease (GVHD) occur.…”

Systematic Nutritional Support in Allogeneic Hematopoietic Stem Cell Transplant Recipients

“…Use of enteral nutrition (EN) can be an important alternative, as Seguy et al reported the possible benefit using EN after HSCT [41][42][43]. Using the gut might be beneficial to maintain its integrity or improve glucose control, which may reduce the risk of GVHD [41,42,44].…”

Parenteral nutrition use in children with cancer

“…Reduction in gut absorptive function that does not require intravenous supplementation to maintain health and/or growth can be termed “intestinal insufficiency or deficiency.” These children often require optimization of dietary calories, oral nutritional supplements, or enteral nutrition (EN) support to meet their energy requirements. EN has been shown to be an effective and well‐tolerated method of feeding in children with cancer and those undergoing hematopoietic stem cell transplant (HSCT) …”