Background Chemotherapy administered during bone marrow transplantation (BMT) causes children to experience vomiting, diarrhoea and mucositis which negatively impact oral intakes and risk malnutrition. Nutrition support becomes necessary to circumvent these adverse effects. This has traditionally been provided via parenteral nutrition (PN), but evidence is increasingly advocating enteral nutrition (EN) as a preferential alternative. This review aimed to determine the efficacy of EN versus PN provided to children ≤18 years undergoing BMT. Primary outcomes included nutritional parameters; secondary outcomes post-transplantation parameters.

Methods Databases searched included MEDLINE, EMBASE, AMED, CINAHL and Cochrane Central. Key journals were hand searched and reference lists scanned. Randomised and observational studies comparing EN versus PN in children ≤18 years undergoing BMT investigating nutritional or post-transplantation outcomes were eligible. As included studies were observational, risk of bias was assessed using the ROBINS-I tool.

Results Six studies were included which were clinically heterogenous regarding populations, interventions and outcomes, at moderate to serious risk of bias due to lack of randomisation, retrospective designs and participant selection. Meta-analyses were not performed and data were presented narratively. Conflicting results in favour of either method of nutrition support, or no difference between methods, were seen for duration of interventions, nutritional intakes, anthropometry, mortality and neutrophil engraftment. EN may provide favourable benefits over PN regarding graft-versus-host-disease (GvHD) and platelet engraftment.

Conclusions This is the first systematic review comparing EN versus PN in pediatric BMT. Results support the growing body of evidence that EN is feasible during BMT. Similar differences regarding many outcomes were seen in both forms of nutrition support, but EN could provide benefits above PN including reduced incidence of GvHD and faster platelet engraftment. Future studies should conduct multi-centre, randomised trials to ensure studies are adequately powered and provide higher quality evidence comparing EN versus PN in paediatric BMT.