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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 47; no. 9; pp. 1191 - 1195
• Main Authors: Azarnoush, S, Bruno, B, Beghin, L, Guimber, D, Nelken, B, Yakoub-Agha, I, Seguy, D
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2012; Nature Publishing Group
• Subjects: 631/250/1904; 631/532; 692/700/1720; 692/700/565/2072; Acute Disease; Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body mass; Body mass index; Body size; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Child; Child, Preschool; Children; Digestive tract; Donors; Enteral feeding; Enteral nutrition; Enteral Nutrition - methods; Female; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation - methods; Humans; Immunological tolerance; Internal Medicine; Leukemia - diet therapy; Leukemia - surgery; Male; Medical sciences; Medicine; Medicine & Public Health; Nutrition; original-article; Parenteral nutrition; Patients; Pediatrics; Platelets; Prospective Studies; Public Health; Stem cell transplantation; Stem Cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplants & implants; Treatment Outcome; Tube feeding; France; enteral nutrition; nutritional status; SCT; children; Human; Hematology; Stem cell; Hematopoietic cell; Homograft; Enteral administration; Allogeneic hematopoietic stem cell transplantation; Graft; Child; Nutritional status; Food supplement
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2011.248

Parenteral nutrition (PN) is the treatment of choice for nutritional support of patients undergoing allo-SCT following myeloablative conditioning (MAC). Here we prospectively assessed the outcomes of early enteral nutrition (EN) in a paediatric cohort. From 2003 to 2010, all 65 consecutive children undergoing MAC allo-SCT at our referral centre began EN the day after transplantation. Post-transplant and nutritional outcomes of patients receiving only EN (EN group, n =50) were compared with those of patients requiring additional PN (EN-PN group, n =15). In the EN group time to platelet recovery ( P =0.01) and length of hospitalisation ( P <0.001) were shorter, while in the EN-PN group the proportion of unrelated donors ( P =0.02) and the frequency of severe acute GVHD (aGVHD; P =0.004) were higher. All patients were alive at day 100. PN was started 14 days after transplant because of poor digestive tolerance to EN or severe gut aGVHD. The body mass index Z -score in the EN-PN group decreased from transplant to discharge ( P =0.02). In only 23% of cases was PN required for severely ill patients. Our results suggest that EN might be considered to be an option for nutritional support in children undergoing MAC allo-SCT, while PN should be used only as a rescue option, possibly in combination with EN.