Impact of Allogeneic Hematopoietic Stem Cell Transplantation on Nutritional Status and Intake in Children

Abstract

Objectives: This study aimed to describe the impact of allogeneic/haploidentical hematopoietic stem cell transplantation on nutritional status and intake in a group of children aged 2 to 18 years. Methods: In an observational study, data were collected prospectively. Patients were prescribed individual nutritional support by hospital routines. Anthropometrics were measured pre-transplant at hospital admission and weekly from the day of transplant (day 0) until day +28. z scores for weight, height, and BMI were calculated using Norwegian growth references to assess nutritional status. Pre-transplant diet was assessed on the day of hospitalization. Nutrient provision from enteral nutrition (EN = oral and tube) and parenteral nutrition (PN) was assessed by daily records from day +1 until day +28, or previous discharge, and compared with recommendations (RI) from the Nordic Nutrition Recommendations and ESPGHAN guidelines. Total energy intake was presented as the percentage (%) of basal metabolic rate (BMR) calculated by the Schofield equation. Macro-and micronutrient provisions were presented as medians (interquartile range) and the % of RI. Results: Twenty-eight patients, mean age 10.3 years (range 3.5-16.6), were included. Two-thirds (n = 18) had malignant diseases. At admission, mean weight Z-score was −0.3, height z scores −0.7, and BMI Z-score 0.1. Eighteen percent (n = 5) were stunted and 25% (n = 7) had overweight. At admission, 25% (n = 7) had established tube feeding, and 7% (n = 2) also had PN. No significant changes in weight z scores were detected during the studied weeks (P = 0.454). The median daily energy provision was 115% (110-123) of BMR and proteins 1.5 (1.3-1.8) g/kg. EN was provided during a median of 93% of the studied days and provided 21% of the energy. PN was given on a median of 96% of the studied days and provided 79% of energy. RI for vitamins, magnesium, and zinc was met. Provision of copper, iodine, selenium, calcium, and phosphate was below RI. Conclusions: Combined EN and PN providing 115% of BMR and 1.5 g/kg protein ensured stable weight by day +28 and covered RI, except for trace elements and minerals.

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

“…Unfortunately, the implementation of this approach is not being executed uniformly in the pediatric BMT population, despite some evidence of its benefits, including decreased length of stay and lower costs [ 22 , 48 ]. In a multicenter, randomized, controlled trial comparing EN versus PN use in critically-ill adults, minimal differences in outcomes were seen between groups, except for higher costs with PN [ 49 ]. 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 ].…”