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Nutrition

Intensive enteral nutrition support in paediatric bone marrow transplantation

Bone Marrow Transplantation volume 27, pages 741–746 (2001)Cite this article

Abstract

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 <85% ideal body weight (IBW) at discharge (range 75–84), only one of whom was <85% 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.

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References

  1. Gratwohl A, Hermans J, Baldomero H et al. Indications for haemopoietic precursor cell transplants in Europe Br J Haematol 1996 92: 35–43

    Article  CAS  Google Scholar 

  2. Sanders JE . Bone marrow transplantation for pediatric malignancies Pediat Clin North Am 1997 44: 1005–1020

    Article  CAS  Google Scholar 

  3. Goldman JM, Schmitz N, Niethammer D, Gratwohl A for the Accreditation Sub-Committee of the European Group for Blood and Marrow Transplantation . Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe in 1998 Bone Marrow Transplant 1998 21: 1–7

    Article  CAS  Google Scholar 

  4. Hoogerbrugge PM, Brouwer OF, Bordigoni P et al. Allogeneic bone marrow transplantation for lysosomal storage diseases. The European Group for Bone Marrow Transplantation Lancet 1995 345: 1398–1402

    Article  CAS  Google Scholar 

  5. Weisdorf SA, Lysne J, Wind D et al. Positive effect of prophylactic total parenteral nutrition on longterm outcome of bone marrow transplantation Transplantation 1987 43: 833–838

    Article  CAS  Google Scholar 

  6. Day DL, Carpenter BL . Abdominal complications in pediatric bone marrow transplant recipients Radiographics 1993 13: 1101–1112

    Article  CAS  Google Scholar 

  7. Iestra JA, Fibbe WE, Zwinderman AH et al. Parenteral nutrition following intensive cytotoxic therapy: an exploratory study on the need for parenteral nutrition after various treatment appraches for haematological malignancies Bone Marrow Transplant 1999 23: 933–939

    Article  CAS  Google Scholar 

  8. Apelgren KN, Wilmore DW . Parenteral nutrition: is it ontologically logical? A response J Clin Oncol 1981 2: 539–544

    Article  Google Scholar 

  9. Szeluga PJ, Stuart RK, Brookmeyer R et al. Nutritional support of bone marrow transplant recipients: a prospective, randomised clinical trial comparing total parenteral nutrition to an enteral feeding programme Cancer Res 1987 47: 3309–3316

    CAS  PubMed  Google Scholar 

  10. American College of Physicians . Parenteral nutrition in patients receiving cancer chemotherapy Ann Intern Med 1989 110: 734–736

    Article  Google Scholar 

  11. Stuart RK, Sensenbrenner LL . Adverse effects of nutritional deprivation on transplanted haematopoietic cells Exp Haematol 1979 7: 435–442

    CAS  Google Scholar 

  12. Inoue S, Epstein MD, Alexander JW et al. Prevention of yeast translocation across the gut by a single enteral feeding after burn injury J Parenter Enter Nutr 1989 13: 565–571

    Article  CAS  Google Scholar 

  13. Moore FA, Moore EE, Jones TN et al. TEN versus TPN following major torso trauma: reduced septic morbidity J Trauma 1989 29: 916–923

    Article  CAS  Google Scholar 

  14. Mulder POM, Bouman JG, Gietema JA et al. Hyperalimentation in autologous bone marrow transplantation for solid tumors Cancer 1989 64: 2045–2052

    Article  CAS  Google Scholar 

  15. Papadopoulou A, MacDonald A, Williams MD et al. Enteral nutrition after bone marrow transplantation Arch Dis Child 1997 77: 131–136

    Article  CAS  Google Scholar 

  16. Pietsch JB, Ford C, Whitlock JA . Nasogastric tube feeding in children with high risk cancer: a pilot study J Ped Hematol Oncol 1999 21: 111–114

    Article  CAS  Google Scholar 

  17. Hoey HM, Tanner JM, Cox LA . Clinical growth standards for Irish children Acta Paediatr Scand Suppl 1987 338: 1–31

    Article  CAS  Google Scholar 

  18. Khoshoo V . Nutritional assessment in children and adolescents Curr Opin 1997 9: 502–507

    Article  CAS  Google Scholar 

  19. Ringwald-Smith K, Krance R, Stricklin L . Enteral nutrition support in a child after bone marrow transplantation Nutr Clin Pract 1995 10: 140–143

    Article  CAS  Google Scholar 

  20. Lansky SB, List MA, Lansky LL et al. The measurement of performance in childhood cancer patients Cancer 1987 60: 1651–1656

    Article  CAS  Google Scholar 

  21. Rickard KA, Godshall BJ, Longhmani ES et al. Integration of nutrition support into oncologic treatment protocols for high and low nutritional risk children with Wilms’ tumour Cancer 1989 64: 491–509

    Article  CAS  Google Scholar 

  22. Papadopoulou A, Holden CE, Paul L et al. The nutritional response to home enteral nutrition in childhood Acta Paediatr 1995 84: 528–531

    Article  CAS  Google Scholar 

  23. Smith DE, Handy DJ, Holden CE et al. An investigation of supplementary nasogastric feeding in malnourished children undergoing treatment for malignancy: results of a pilot study J Hum Nutr 1992 5: 85–91

    Article  Google Scholar 

  24. Copeman MC . Use of total parenteral nutrition in children with cancer: a review and some recommendations Pediatr Hematol Oncol 1994 11: 463–470

    Article  CAS  Google Scholar 

  25. Papadopoulou A, Nathavitharana KA, Williams MD et al. Diarrhoea and weight loss after bone marrow transplantation in children Pediatr Hematol Oncol 1994 11: 601–611

    Article  CAS  Google Scholar 

  26. Heubi JE . Whenever possible, use the gut J Ped Hem Oncol 1999 21: 88–89

    Article  CAS  Google Scholar 

  27. Moore FA, Feliciano DV, Andrassy J et al. Early enteral feeding, compared with parenteral, reduces postoperaive septic complications. The result of a meta-analysis Ann Surg 1992 216: 172–183

    Article  CAS  Google Scholar 

  28. Iiboshi Y, Nezu R, Kennedy M et al. Total parenteral nutrition decreases luminal mucous gel and increases permeability of small intestine J Parenter Enter Nutr 1994 18: 346–350

    Article  CAS  Google Scholar 

  29. Papadopolou A, Lloyd DR, Williams MD et al. Gastrointestinal and nutritional sequelae of bone marrow transplantation Arch Dis Child 1996 75: 208–213

    Article  Google Scholar 

  30. List AF, Speir C, Greer J et al. Phase I/II trial of cyclosporin as a chemotherapy-resistance modifier in acute leukaemia J Clin Oncol 1998 11: 1652–1660

    Article  Google Scholar 

  31. Motil KJ, Altchuler Si, Grand RJ . Mineral balance during nutritional supplementation in adolescents with Crohn disease and growth failure J Pediatr 1985 107: 473–479

    Article  CAS  Google Scholar 

  32. Kauf E, Fuchs D, Winnefeld K et al. Blood selenium content after conditioning and during the course of bone marrow transplantation in children with malignant disease Med Klin 1997 92: 46–47

    Article  Google Scholar 

  33. Papadopoulou A . Nutritional considerations in children undergoing bone marrow transplantation Eur J Clin Nutr 1998 52: 863–871

    Article  CAS  Google Scholar 

  34. Goringe AP, Brown S, O'Callaghan U et al. Glutamine and vitamin E in the treatment of hepatic veno-occlusive disease Bone Marrow Transplant 1998 21: 829–832

    Article  CAS  Google Scholar 

  35. Van der Hulst RRWJ, von Meyenfeldt MF, van Kreel BK et al. Glutamine and the preservation of gut integrity Lancet 1993 341: 1363–1365

    Article  CAS  Google Scholar 

  36. Alverdy JC . Effects of glutamine supplemented diets on immunology of the gut J Parenter Enter Nutr 1990 14: 109S–113S

    Article  CAS  Google Scholar 

  37. Ziegler TR, Young LS, Benfell K et al. Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation Ann Intern Med 1992 116: 821–828

    Article  CAS  Google Scholar 

  38. Schloerb PR, Amare M . Total parenteral nutrition with glutamine in bone marrow transplantation and other clinical applications (a randomised double blind study) J Parenter Enter Nutr 1993 17: 407–413

    Article  CAS  Google Scholar 

  39. Hermann VM, Petruska PJ . Nutrition support in bone marrow transplant recipients Nutr Clin Pract 1993 8: 19–27

    Article  Google Scholar 

  40. Bearmann SI . The syndrome of hepatic veno-occlusive disease after bone marrow transplantation Blood 1995 85: 3005–3020

    Google Scholar 

  41. Essel JH, Thompson JM, Harman GS et al. Pilot trial of prophylactic ursodiol to decrease the incidence of veno-occlusive disease of the liver in allogeneic bone marrow transplant patients Bone Marrow Transplant 1992 10: 367–372.

    Google Scholar 

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Acknowledgements

We would like to thank the Dietetics Dept for their commitment to the success of the programme and to the medical and nursing staff, without whose co-operation, this study would not have been possible.

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Authors and Affiliations

  1. Department of Haematology and Oncology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland

    A Langdana, E Molloy & A O'Meara

  2. Department of Dietetics, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland

    N Tully

  3. Department of Gastroenterology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland

    B Bourke

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  1. A Langdana
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  2. N Tully
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  3. E Molloy
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  4. B Bourke
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  5. A O'Meara
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Langdana, A., Tully, N., Molloy, E. et al. Intensive enteral nutrition support in paediatric bone marrow transplantation. Bone Marrow Transplant 27, 741–746 (2001). https://doi.org/10.1038/sj.bmt.1702855

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