Enteral nutrition after bone marrow transplantation
a Institute of Child Health,
University of Birmingham, b The Children's Hospital, Birmingham
Correspondence to: Dr A Papadopoulou, First Department of Paediatrics, `P & A Kyriakou' Children's Hospital, Thivon & Levadias, Athens 115 27, Greece.
Accepted 16 April 1997
Nutritional insult after bone marrow transplantation (BMT) is
complex and its nutritional management challenging. Enteral nutrition
is cheaper and easier to provide than parenteral nutrition, but its
tolerance and effectiveness in reversing nutritional depletion after
BMT is poorly defined. Nutritional status, wellbeing, and nutritional
biochemistry were prospectively assessed in 21 children (mean age 7.5 years; 14 boys) who received nasogastric feeding after BMT (mean
duration 17 days) and in eight children (mean age 8 years, four boys)
who refused enteral nutrition and who received dietetic advice only.
Enteral nutrition was stopped prematurely in eight patients. Greater
changes in weight and mid upper arm circumference were observed in the
enteral nutrition group, while positive correlations were found between
the duration of feeds and increase in weight and in mid upper arm
circumference. Vomiting and diarrhoea had a similar incidence in the
two groups, while fever and positive blood cultures occurred more
frequently in the dietetic advice group. Diarrhoea occurring during
enteral nutrition was not associated with fat malabsorption, while
carbohydrate malabsorption was associated with rotavirus infection
only. Enteral feeding did not, however, affect bone marrow recovery,
hospital stay, general wellbeing, or serum albumin concentrations.
Hypomagnesaemia, hypophosphataemia, zinc and selenium deficiency were
common in both groups. In conclusion, enteral nutrition, when
tolerated, is effective in limiting nutritional insult after BMT. With
existing regimens nutritional biochemistry should be closely monitored
in order to provide supplements when required.
© 1997 by Archives of Disease in Childhood
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