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Proactive enteral nutrition for patients undergoing allogeneic stem cell transplantation- implementation and clinical outcomes

European Journal of Clinical Nutrition volume 78, pages 251–256 (2024)Cite this article

Subjects

Abstract

Background/ Objectives

Nutrition support is frequently required post allogeneic haematopoietic progenitor cell transplantation (HPCT) however the tolerance of enteral nutrition (EN) can vary. This mixed methods study aimed to explore staff perceptions, barriers and enablers to the use of EN post HPCT and report the implementation and outcomes of a nutrition protocol.

Subject/ Methods

A survey on barriers and enablers to the use of EN was developed and distributed to medical and nursing staff. Data on nutrition and clinical outcomes was collected for 12 months post implementation of a new nutrition protocol.

Results

Thirty staff completed the survey, key barriers identified included uncertain EN tolerance, lack of confidence in nasogastric tube placement and insufficient training and resources. Eighty-four patients commenced EN, 23 changed to PN (27%) and 61 received EN only (73%). In total 36 patients received PN and eight patients oral nutrition support only. There was a difference in type of conditioning (p = 0.025) and nutritional status (p = 0.016) between patients who received PN vs EN only, with a higher proportion of malnourished patients receiving PN (23% vs 5%). Patients who received PN had a longer length of hospital stay (median 22 vs 19 days, p = 0.012) and lower rate of survival to day 100 (81% vs 95%, p = 0.036) than patients who received EN.

Conclusion

The use of EN may lead to improved clinical outcomes compared to PN therefore should be implemented as first line nutrition support.

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Data availability

The datasets analysed during the current study are not publicly available due to ethics requirements.

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Funding

This research was supported by grants from the Royal Brisbane & Women’s Hospital Research Foundation. The funding body has no role in the study design, data collection, analysis, interpretation or in the manuscript preparation.

Author information

Authors and Affiliations

  1. School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia

    Sarah Andersen, Merrilyn Banks & Teresa Brown

  2. Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD, 4029, Australia

    Sarah Andersen, Rebecca Fichera, Merrilyn Banks & Teresa Brown

  3. Department of Clinical Haematology, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD, 4029, Australia

    Glen Kennedy, Nicholas Weber & David Williams

  4. Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia

    Judy Bauer

Authors
  1. Sarah Andersen
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Contributions

Phase one study: SA: conceptualisation, methodology, funding acquisition, investigation, formal analysis, writing original draught, writing review and editing, project administration. NW: methodology, writing review and editing. TB: methodology, writing review and editing. GK: methodology, writing review and editing. MB: conceptualisation, methodology, writing review and editing. JB: conceptualisation, methodology, writing review and editing. Phase two study: SA: conceptualisation, methodology, investigation, formal analysis, writing original draught, writing review and editing. RF: conceptualisation, methodology, investigation, writing review and editing. TB: methodology, writing review and editing. GK: methodology, writing review and editing. MB: methodology, writing review and editing. JB: writing review and editing. DW: methodology, writing review and editing. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Sarah Andersen.

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Competing interests

The authors declare no competing interests.

Ethical approval

Phase one study: Approved by the RBWH Human Research Ethics Committee (HREC/18/QRBW/321) and University of Queensland Human Research Ethics Board (approval 2018001520). Phase two study: received an exemption from ethics approval from the RBWH Human Research Ethics Committee.

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Andersen, S., Fichera, R., Banks, M. et al. Proactive enteral nutrition for patients undergoing allogeneic stem cell transplantation- implementation and clinical outcomes. Eur J Clin Nutr 78, 251–256 (2024). https://doi.org/10.1038/s41430-023-01367-8

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