Background Enteral nutrition (EN) is becoming recognised as having advantages over parenteral nutrition (PN) and recommended as first-line nutrition support in children undergoing bone marrow transplantation (BMT). EN has traditionally been provided via nasogastric tube (NGT). Gastrostomies avoid complications associated with NGTs including dislodgement through vomiting and could provide a preferential alternative. This study compared nutritional and post-transplantation outcomes between children who had a gastrostomy placed pre-BMT versus those who had not.

Methods Prior to BMT admission families within our centre are offered the choice between an NGT or gastrostomy. A retrospective cohort study was undertaken comparing children who had a gastrostomy placed pre-BMT (the gastrostomy group: n=54), and children who did not (the non-gastrostomy group: n=91). Children transplanted between 2014-2018 within a single centre were included.

Results Children in the gastrostomy group required less PN (OR 0.4; 95% CI 0.2-0.9; p=0.049), initiated PN later if required (HR 0.6; 95% CI 0.4-0.8; p=0.005), and more frequently required EN post-discharge (OR 2.4; 95% CI 1.1-5.4; p=0.029). No differences were found between groups on length of admission, positive blood cultures and changes in weight or albumin during admission. Within the non-gastrostomy group, 21% refused NGTs and received first-line PN. These children (n=19) were older than those who received first-line EN (n=126) (mean (SD) 9.3 (4.0) versus 5.2 (3.9) years; 95% CI -6.0 to -2.2; p<0.001).

Conclusions To our knowledge this is the first study investigating outcomes of gastrostomy feeding in paediatric BMT. Providing EN via gastrostomy is feasible and may be more acceptable to older children than NGTs. The results will allow clinicians and families to make more informed decisions regarding gastrostomy placement prior to admission. Weighing the risks and benefits of gastrostomy placement in these children is a challenging decision. Further research investigating safety and family perceptions of gastrostomies is required.