Nutritional considerations in children undergoing bone marrow transplantation

Summary:The aims of this study were to establish the nutritional status of children pre-BMT and to determine whether predictive methods of assessing nutritional status and resting energy expenditure (REE) are accurate in this population. We analysed the body cell mass (BCM) (n ¼ 26) and REE (n ¼ 24) in children undergoing BMT. BCM was adjusted for height (BCM/HT p ) and expressed as a Z score to represent nutritional status. To determine whether body mass index (BMI) was indicative of nutritional status in children undergoing BMT, BMI Z scores were compared to the reference method of BCM/ HT p Z scores. Schofield predictive equations of basal metabolic rate (BMR) were compared to measured REE to evaluate the accuracy of the predictive equations. The mean BCM/HT p Z score for the subject population was À1.0971.28. There was no significant relationship between BCM/HT p Z score and BMI Z score (r ¼ 0.34; P40.05); however there was minimal difference between measured REE and predicted BMR (bias ¼ À117 149 kcal/day). The results of this study demonstrate that children undergoing BMT may have suboptimal nutritional status and that BMI is not an accurate indication of nutritional status in this population. However, Schofield equations were found to be suitable for representing REE in children pre-BMT. Bone Marrow Transplantation (2005) 35, 775-779.

Section: Discussionmentioning

confidence: 99%

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

White

Murphy

Hastings

et al. 2005

“…31 Trace elemental deficiency, most notably copper, zinc and selenium have also been reported following transplant, possibly related to tubular dysfunction, 32 resulting in increased peritransplant morbidity. 33 While trace elements were not monitored in this study, all NG formulae were nutritionally complete.…”

Section: Discussionmentioning

confidence: 99%

Intensive enteral nutrition support in paediatric bone marrow transplantation

Langdana

Tully

Molloy

et al. 2001

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

“…25 In addition, increased energy requirement, fluid restrictions and hepatotoxicity of PN make it difficult to provide adequate nutrition consistently. 26 To ensure the nutritional status of patients during HSCT is optimal, it is crucial that nutritional status be monitored accurately and that individual energy requirements provided. Impaired nutritional status before HSCT has been known to be a negative prognostic factor, whereas well-nourished patients having a shorter engraftment time.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of nutritional status in patients undergoing hematopoietic SCT

Hadjibabaie

Iravani

Taghizadeh

et al. 2008

The aims of this study were to establish the nutritional status of patients during hematopoietic SCT (HSCT) and to determine if body mass index (BMI) is a valid indicator of nutritional status in this population when compared with nitrogen balance (NB). In total, 50 patients were enrolled (mean age: 25.7 ± 9.0 years). Patients (14%) were underweight (BMIo18.5 kg/m 2 ), 58% in a normal BMI (between 18.5 and 24.9 kg/m 2 ) and 28% were overweight or obese (BMIX25 kg/m 2 ). NB dropped after transplantation and increased from days þ 5 to þ 20 after transplantation (P ¼ 0.006). There was a significant negative relationship between patients' BMI and time to engraftment (r ¼ À0.45, P ¼ 0.001). Engraftment of underweight patients was 3.0 days (P ¼ 0.002) and 4.0 days (Po0.001) later than in normal and overweight or obese patients, respectively. There was no significant correlation between NB before transplantation and time to engraftment (r ¼ À0.22, P ¼ 0.16). The results of this study demonstrate that patients undergoing HSCT may have suboptimal nutritional status and that pre-HSCT-BMI rather than NB may have a greater correlation in HSCT patients with the time of engraftment. Therefore, it may be useful to consider patient's BMI before transplantation for earlier engraftment time.