Total parenteral nutrition in bone marrow transplant: what is the appropriate energy level?

Abstract

Objectives: Total parenteral nutrition (TPN), recommended during bone-marrow transplant (BMT), is often withheld following complications. We aim to determine the effective amount of energy supplied and its short-term effects in children requiring BMT.

Methods: Twenty children (11 males, 9 females, mean age 8 years, range 1-18 years) receiving 13 allogenic and 7 autologous BMT for malignant (13) and nonmalignant (7) diseases, were retrospectively evaluated for energy/protein intakes, weight changes, time to engraftment and on TPN, occurrence of complications, and metabolic abnormalities.

Results: Each child received approximately 72% of the prescribed calories, an average of 0.87 +/- 0.2 x basal-metabolic rate, 1.14 +/- 0.4 g protein/kg/day, and 176 +/- 34:1 nonprotein calories:nitrogen ratio. Body weight improved during the 35 days (range 14-62) of TPN, with loss thereafter. Engraftment occurred in 20 +/- 7.5 days. Caloric intake and time to engraftment were related (p = 0.002). Ten central-venous-line and 12 gastrointestinal infections occurred. Among laboratory abnormalities, liver function tests resulted temporarily altered in 10 patients, and permanently in 1 child with cholestasis. Eight children developed graft-versus-host disease. Five died of cancer.

Conclusions: The energy supplied with TPN in BMT is less than expected and approximately covers the BMR with mixed effects. Energy intake needs to be calibrated during TPN and adjusted during feeding resumption to expedite recovery.