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Abstract
Total parenteral nutrition (TPN) is often used to support children through cancer treatment. Most commonly TPN is necessary due to chemotherapy-induced feeding intolerance but may also be needed in other situations such as sepsis. However, parenteral nutrition (PN) is not without its own risks in this vulnerable group of patients. This study aimed to describe demographically the typical patients who require nutritional support with PN during the course of their chemotherapy due to difficulties taking food enterally. With this information clinicians would be better placed to predict, at the start of chemotherapy treatment, which children will go on to require PN; ultimately this could allow for pre-emptive management of these patients with naso-jejunal tube placement and enteral feeding, forgoing the need for PN.
A retrospective study was carried out using patient treatment data from electronic and paper records; all patients at one regional oncology treatment centre within a 27-month period who had required PN were included. These 44 patients had a total of 61 discrete episodes on PN. For context, data for patients on cancer treatment in the same period who did not have PN were collected also. Episodes of PN were divided into three groups according to length – 5 days or fewer, 6–27 days or 28 days or more. These groups and cumulative patient days on PN were then evaluated with oncology diagnosis, age, gender, and the chemotherapeutic agents received prior to the episode of PN.
We conclude firstly that PN is generally being used appropriately – we considered that those patients who received 5 or fewer days of PN could have been managed with enteral feeding, but these made up just 13% of episodes. Prolonged periods of PN of more than 28 days are not common. Secondly it is clear to see that certain oncological diagnoses and chemotherapeutic agents make a patient very much more likely to require support with PN.
This information would be invaluable for clinicians in preparing patients and families for treatment and more effectively managing nutrition in these children. Expanding this further to a larger, multi-centre study would give more robust data.
PN requirement by diagnosis
Patient days of PN by diagnosis