Enteral Nutrition and Bone Marrow Transplantation

Abstract

This retrospective study evaluated the efficacy of enteral nutrition for pediatric patients undergoing the challenging treatment of allogeneic bone marrow transplantation. During the period from January 1999 to May 2000, 15 patients were transplant recipients. On admission to the hospital, 87% of patients were above the 50th percentile for weight for age. Nasogastric tubes were inserted while platelet counts remained greater than 50 x 10(9) mL/L. A specialized elemental formula for pediatric patients was commenced. These feeds were administered continuously and were titrated until caloric requirement or tolerance level had been achieved. During hospitalization for bone marrow transplantation, enteral nutrition was the major form of nutritional support for all patients. Enteral feeds continued even during maximal gut toxicity and were supported with antiemetics and analgesia. There were insignificant weight fluctuations during hospitalization, with 80% of children above the 50th percentile weight for age being discharged. Enteral nutrition via a nasogastric tube was effective in the provision of nutrition during bone marrow transplantation and continues to have an important role in this unit.

Erratum

“…Advantages of EN over PN in the transplant recipients have not been studied comprehensively, and studies did not reveal whether EN or PN was more efficient 15. However, the limited data of pediatric patients undergoing bone marrow transplantation should be encouraged to have an oral–enteral diet, as they could less likely to experience infections,frequency of GVHD, better nutritional responce, tolerability and more likely to go home earlier 1, 5–7, 10, 11, 17.…”

“…It helps to maintain intestinal function and integrity, and reduces potential bacterial translocation and is associated with minimal complications 2, 5–6. There are limited data about EN with nasogastric tube (NG) in children undergoing HSCT 7–11. As the practice of EN in children undergoing HSCT was not stressed enough in large numbers in the literature, we therefore aimed to evaluate its feasibility and efficacy in this study.…”

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) …”

“…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). [18][19][20][21][22] Intestinal failure occurs when gut function falls below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, and intravenous nutrition support may be required to meet energy, fluid, and electrolyte requirements and prevent or correct malnutrition. 17 Parenteral nutrition (PN) is an intravenous solution containing macronutrients (protein, carbohydrate, and fat) and micronutrients (vitamins and minerals), which is given through a catheter into a large vein to provide nutrition in children who cannot be fully fed by the oral or enteral route in order to sustain growth and prevent or correct malnutrition.…”

Predictors of gastrostomy placement in children with inherited metabolic diseases treated by umbilical cord blood transplantation

“…Enteral nutrition (EN) via a surgically placed gastrostomy is the preferred method for supplementing nutrition at our institution. Although there are conflicting data, greater improvements in nutritional status and decreased rates of intestinal GVHD and infections have been seen in UCBT patients fed via EN compared to those administered parenteral nutrition (PN) [4,[7][8][9][10]. The cost of PN is also significantly higher than EN [11].…”