In the challenging and complex treatment landscape for pediatric allogenic bone marrow transplantation (BMT), nutrition support plays a pivotal role in patient care and recovery. A recent retrospective cohort study, conducted by researchers from the Department of Nutrition and Dietetics at Great Ormond Street Hospital for Children in London, shines a light on the significant benefits of using gastrostomy feeding as an early intervention for nutritional support in this vulnerable patient population.

Published in the Clinical Nutrition ESPEN journal, the research paper titled “Early outcomes of gastrostomy feeding in paediatric allogenic bone marrow transplantation: A retrospective cohort study” explores the advantages of enteral nutrition (EN), particularly delivered through gastrostomy, compared to traditional nutrition support methods. With the study’s DOI: 10.1016/j.clnesp.2019.02.014, it presents a substantial examination into how gastrostomy feeding can impact early post-transplantation outcomes.

Study Overview and Methodology

Led by James J. Evans from the Department of Nutrition and Dietetics, along with colleagues Justin J. Needle and Shashivadan P. Hirani from the School of Health Sciences at City, University of London, the team delved into electronic medical records capturing data from January 2014 to May 2018. The cohort included 145 children who underwent BMT at the same medical center.

These patients were divided into two groups based on whether they received a prophylactic gastrostomy for nutrition support prior to their BMT (gastrostomy group, n = 54) or were managed with other nutrition support methods, such as nasogastric tubes (NGT) or parenteral nutrition (PN) without the use of gastrostomy (non-gastrostomy group, n = 91).

Comparisons and Results

By retrospectively analyzing and comparing clinical outcomes between the two groups, the researchers aimed to determine the impact of gastrostomy feeding on the use of parenteral nutrition, time to PN initiation, EN as first-line nutrition support, and the necessity of EN post-discharge. Their multivariate regression analyses revealed several key findings:

Children in the gastrostomy group were significantly less likely to require PN (odds ratio (OR) 0.4; 95% confidence interval (CI) 0.2-0.9; P = 0.049).
If PN was required, those with gastrostomies initiated PN later (hazard ratio 0.6; 95% CI 0.4-0.8; P = 0.005).
The gastrostomy group was more likely to receive EN as the first-line nutrition support (P < 0.001).
Post-discharge, gastrostomy patients more frequently required enteral support (OR 2.4; 95% CI 1.1-5.4; P = 0.029).

Notably, no significant differences emerged between the gastrostomy and non-gastrostomy groups concerning the length of admission, overall survival rates at day 100 post-transplant, incidence of graft-versus-host disease, positive blood cultures, or variations in weight or albumin levels during the admission period.

Implications and Recommendations

The findings underscore the feasibility of providing enteral nutrition via gastrostomy in pediatric BMT patients and suggest a potentially more acceptable route for older children compared to NGTs. The study’s outcomes narrate a compelling argument in favor of gastrostomy feeding, considering both nutritional benefits and the reduction of PN dependency, which is frequently associated with higher costs and complications.

While gastrostomy placement represents a critical intervention, the authors recognize the complex decision-making process involved in choosing this route for high-risk pediatric patients. The study advocates for further rigorous research to bolster understanding of the safety considerations, long-term outcomes, and family perspectives on the use of gastrostomy feeding.

The Future of Nutrition Support in Pediatric BMT

Moving forward, evaluations of gastrostomy feeding should focus on optimizing the nutrition therapy protocol for pediatric patients undergoing BMT. Comprehensive investigations that include clinical trials, quality-of-life assessments, cost-effectiveness analyses, and long-term follow-ups are essential. As healthcare professionals strive to provide tailored care, embracing advances in nutritional support remains a cornerstone of effective BMT recovery protocols.

Conclusion

The study published in the Clinical Nutrition ESPEN journal represents a substantial contribution to pediatric BMT care. It underscores the value of gastrostomy feeding in enhancing early outcomes and highlights the importance of EN as a preferred mode of nutritional support. Considering the delicate balance between benefits and risks, this research underpins the necessity for a patient-centered approach when evaluating gastrostomy placement for nutritional support in pediatric BMT patients.

Keywords

1. Pediatric Bone Marrow Transplantation
2. Gastrostomy Feeding
3. Nutritional Support BMT
4. Enteral Nutrition Children
5. Parenteral Nutrition Reduction

References

1. Evans, J. J., Needle, J. J., & Hirani, S. P. (2019). Early outcomes of gastrostomy feeding in paediatric allogenic bone marrow transplantation: A retrospective cohort study. Clinical Nutrition ESPEN, 31, 71-79. DOI: 10.1016/j.clnesp.2019.02.014
2. Dalle, J. H., & Masetti, R. (2019). Nutritional issues in pediatric hematopoietic stem cell transplantation. Nutrition in Clinical Practice, 34(3), 387-395. DOI: 10.1002/ncp.10251
3. Aquino, V. M., et al. (2016). Enteral nutritional support by gastrostomy tube in children with cancer. Journal of Pediatric Hematology/Oncology, 38(6), 493-497. DOI: 10.1097/MPH.0000000000000579
4. Seguy, D., et al. (2019). Nutritional support and quality of life in pediatric patients with cancer requiring hematopoietic stem cell transplantation. Supportive Care in Cancer, 27(9), 3641-3648. DOI: 10.1007/s00520-019-04656-4
5. Cober, M. P., & Teitelbaum, D. H. (2010). Prevention of parenteral nutrition-associated liver disease: Role of omega-3 fish oil. Current Opinion in Organ Transplantation, 15(3), 334-339. DOI: 10.1097/MOT.0b013e3283384ba3