J Clin Nutr.  2018 Jun;10(1):9-19. 10.15747/jcn.2018.10.1.9.

Effects of Parenteral Nutrition in Pediatric Patients with Hematopoietic Stem Cell Transplantation

• Lim SY
• Jung MJ
• Park JE
• Kim JS
• Kim SH
• Lyu CJ
• Son ES

• KMID: 2437436
• DOI: http://doi.org/10.15747/jcn.2018.10.1.9

Abstract

PURPOSE
This study examined the effects of parenteral nutrition (PN) on the nutritional status, clinical improvement, and PN-related complications in pediatric patients who had undergone hematopoietic stem cell transplantation (HSCT).
METHODS
A retrospective audit of 110 pediatric patients (age≤18), who underwent HSCT from March 2015 to February 2017 was undertaken. The patients were divided into 3 groups based on the ratio of daily calorie supplementation to the daily calorie requirement (ROCS). The clinical factors related to the nutritional status, such as difference in body weight (BW), body mass index (BMI), percent ideal body weight (PIBW), total protein (T.protein), and albumin; the early clinical outcome, such as PN-duration, length of hospitaliaztion (LOH), engraftment day (ED), graft-versus-host disease, sepsis, pneumonia and mucositis; and PN-related complications, including elevation of total bilirubin (T.bil), direct bilirubin (D.bil), aspartate aminotransferase, alanine aminotransferase, glucose and cholesterol levels, and hepatic veno-occlusive disease were analyzed using the electronic medical records. Additional analysis subject to auto-HSCT and allo-HSCT patients was also performed.
RESULTS
The very-low-ROCS, low-ROCS, and satisfied-ROCS group were 30 (27.3%), 47 (42.7%), and 33 (30.0%) patients, respectively. The PN-duration (P=0.005, z=−2.271), LOH (P=0.023, z=−2.840), ED (P < 0.001, z=−3.695), T.bil elevation (P < 0.001, z=−3.660), and D.bil elevation (P=0.002, z=−3.064) tended to decrease with increasing ROCS. The difference in the PN-duration (P=0.017), ED (P=0.001), T.bil elevation (P=0.001), and D.bil elevation (P=0.011) in the 3 groups was statistically significant. In the auto-HSCT patients, the change in BW (P=0.031, z=+2.154), PIBW (P=0.029, z=+2.187), and BMI (P=0.021, z=+2.306) tended to increase. In the allo-HSCT patients, the change in T.protein (P=0.022, z=+2.286) increased but the ED (P=0.021, z=−2.304) decreased.
CONCLUSION
Aggressive PN supplementation has an effect on maintaining the nutritional status and achieving better early outcomes in pediatric HSCT patients, whereas it has no effect on increasing the PN-related complications.

Keyword

Hematopoietic stem cell transplantation; Parenteral nutrition; Pediatrics

MeSH Terms

Alanine Transaminase
Aspartate Aminotransferases
Bilirubin
Body Mass Index
Body Weight
Cholesterol
Electronic Health Records
Glucose
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Hepatic Veno-Occlusive Disease
Humans
Ideal Body Weight
Mucositis
Nutritional Status
Parenteral Nutrition*
Pediatrics
Pneumonia
Retrospective Studies
Sepsis
Alanine Transaminase
Aspartate Aminotransferases
Bilirubin
Cholesterol
Glucose