Intensive enteral nutrition support in paediatric bone marrow transplantation

Abstract

Summary:This study retrospectively analyses the experience with an intensive enteral feeding protocol in children undergoing BMT at the National Paediatric BMT Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin. Fifty-three patients were transplanted between January 1996 and December 1998; 42 patients received allogeneic transplants, (19 unrelated) and 11 were autologous. Indications included ALL (21), ANLL (3), CML (3), JCML (1), MPS (5), WAS (2), AA/FA (6), NHL/HD (3) and solid tumours (9). Nasogastric (NG) tubes were inserted electively either during conditioning or within the first week when voluntary oral intake had decreased. Nineteen patients were commenced on a whole protein-based formula, 28 on a semi-elemental preparation and two were commenced on an elemental feed. All were maintained on an elemental formula during the period of maximal gut toxicity.Tubes which were vomited were promptly replaced and morphine infusions were routinely employed until mucositis had resolved. Of 49 evaluable patients, 42 (86%) were maintained exclusively on enteral nutrition and seven required parenteral nutrition. Seven patients weighed Ͻ85% ideal body weight (IBW) at discharge (range 75-84), only one of whom was Ͻ85% IBW at 3 months. Twenty-two patients continued on NG feeds following discharge (median 41 days). No patient had veno-occlusive disease. The programme was overwhelmingly endorsed by patients and/or parents but required intensive multidisciplinary counselling to ensure success. Bone Marrow Transplantation (2001) 27, 741-746. Keywords: enteral feeding; children; BMT Bone marrow transplantation (BMT) is recognised as standard therapy for patients with high risk leukaemia and a variety of stem cell disorders ranging from immunodeficiencies to inborn errors of metabolism. [1][2][3][4] The catabolic effects of high-dose chemotherapy, total body irradiation

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

“…In Langdana's study, 86% of children were maintained exclusively on EN, with a mean percentage ideal body weight at discharge of 97%. 10 In the present study, 92% of patients maintained satisfactory nutritional status, and lost less than 10% of their body weight from transplant to discharge. But malnutrition may have been underestimated in the EN-PN group, as two-thirds of patients had hypoalbuminaemia usually associated with oedema.…”

“…14 An EN program must be supported by a committed team (nurses, gastroenterologist and dieticians). 10,14 It should be noted that patients in the EN-PN group patients tended to be older than the others, suggesting that teenagers are reluctant to embark on such a regimen. In the Hopman study, 13 tolerance was significantly better in younger patients (mean age 3.3 vs 8 years of age).…”

“…19 Therefore, Szeluga et al 15 conducted a randomised trial comparing 31 PN with 30 EN cases in allo-and auto-SCT patients above 10 years of age; they concluded that PN was no more effective than EN, and suggested that it should be reserved for patients demonstrating intolerance to EN. Three paediatric studies concluded that EN was an effective nutritional support in SCT: Langdana et al 10 and Papadopoulou et al 12 studied EN (49 and 21 patients, respectively) in both allo-and auto-SCT children, while Hopman et al 13 compared 12 EN vs 22 PN cases in allo-SCT children. However, most studies included only a small number of patients or a heterogeneous patient population of paediatric and adult patients with solid tumours, haematological malignancies, and both auto-and allo-SCT.…”

Nutritional status and energy expenditure in children pre-bone-marrow-transplant

“…Conditioning regimens, mucositis and the possibility of gut graft-versus-host disease result in poor functional integrity of the gastrointestinal tract during BMT and can make feeding challenging. 1,4 In addition, increased energy requirements, fluid restrictions and hepatotoxicity of parenteral nutrition often result in minimal opportunity to provide adequate nutrition consistently. 5 It can be difficult to evaluate the efficacy of nutritional support during the BMT, as biochemical indexes have been shown to inaccurately reflect changes in nutritional status of BMT recipients.…”

Systematic Nutritional Support in Allogeneic Hematopoietic Stem Cell Transplant Recipients

“…Using the gut might be beneficial to maintain its integrity or improve glucose control, which may reduce the risk of GVHD [41,42,44]. Other groups also reported feasibility and promising results of using EN after HSCT [45][46][47]. The major limitation of EN in HSCT is the difficulty of inserting EN tubes in patients with severe mucositis or gastrointestinal tract damage.…”