NUTRITIONAL SUPPORT IN CHILDREN UNDERGOING BONE-MARROW TRANSPLANTATION

Nutritional status and 'well-being' were compared prospectively in 39 children (mean age 8.1 years) who received nutritional support followi ng bone marrow transplantion (BMT): 20 received enteral tube feeding ( ETF; six received parenteral nutrition [PN] subsequently) and 19 with oral mucositis received PN tone received ETF subsequently). Poor nutri tional status (height for age and/or weight for height and/or mid-arm circumference z-scores <-1) was present in 18 patients and was associa ted with a longer hospital stay (P = 0.01). Both ETF and PN groups wer e comparable with respect to age, pretransplant nutritional status and conditioning regimens. No significant deterioration in anthropometric indices in either group occurred following BMT. However, significant correlations were found between the duration of ETF land not PN) and i mprovements in nutritional status. Furthermore, PN was associated with more frequent exocrine pancreatic insufficiency than ETF (P = 0.001). Oral mucositis was associated with poorer 'well being' at the start o f PN compared with ETF (P < 0.0001), but this was reversed by the end of PN. Bone marrow recovery, hospital stay and positive blood cultures were similar in the two groups. Hypomagnesaemia, hypophosphataemia an d biochemical zinc deficiency were common in both groups but hypoalbum inaemia and biochemical selenium deficiency were worse in the PN group . In conclusion, both ETF and PN are effective in maintaining nutritio nal status post-BMT. When ETF is tolerated, it is associated with bett er nutritional response. With the existing ETF and PN regimens close m onitoring of the trace element and mineral status is required.