Enteral nutrition protects children undergoing allogeneic hematopoietic stem cell transplantation from blood stream infections

Abstract

Enteral Nutrition (EN) is recommended as first line nutritional support for patients undergoing Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT), but only few studies exist in the literature which compare EN to Parenteral Nutrition (PN) in the paediatric population.Forty-two consecutive paediatric patients undergoing allo-HSCT at our referral centre between January 2016 and July 2019 were evaluated. Post-transplant and nutritional outcomes of patients receiving EN for more than 7 days (EN group, n = 14) were compared with those of patients receiving EN for fewer than 7 days or receiving only PN (PN group, n = 28). In the EN group, a reduced incidence of Blood Stream Infections (BSI) was observed (p = 0.02) (n = 2 vs. n = 15; 14.3% vs. 53.6%). The type of nutritional support was also the only variable independently associated with BSI in the multivariate analysis (p = 0.03). Platelet engraftment was shorter in the PN group than in the EN group for a threshold of > 20*10⁹/L (p = 0.04) (23.1 vs 35.7 days), but this correlation was not confirmed with a threshold of > 50*10⁹/L. The Body Mass Index (BMI) and the BMI Z-score were no different in the two groups from admission to discharge.Our results highlight that EN is a feasible and nutritionally adequate method of nutritional support for children undergoing allo-HSCT in line with the present literature. Future functional studies are needed to better address the hypothesis that greater intestinal eubyosis maintained with EN may explain the observed reduction in BSI.

Keywords: Blood stream infections; Enteral nutrition; Gut microbiota; Hematopoietic stem cell transplantation; Paediatrics; Parenteral nutrition.

Fig. 1

Flowchart of subject recruitment and nutritional support modalities. Abbreviations: EN = Enteral Nutrition; n = number of patients; PN = Parenteral Nutrition

Fig. 2

Mean BMI during hospitalisation in the EN and PN groups. There was no statistically significant difference in BMI and BMI Z-score at any time point between the EN group and the PN group from admission to discharge. The timing of start of the oral realimentation is highlighted in the figure. Abbreviations: BMI = Body Mass Index; EN = Enteral Nutrition; HSCT = Haematopoietic Stem Cell Transplantation; PN = Parenteral Nutrition

Fig. 3

Cumulative Incidence of BSI in the EN and PN groups. Cumulative incidence was calculated using the Kalbfleisch and Prentice method and compared using the Gray test. Abbreviations: BSI = Blood Stream Infection; E = number of Events; EN = Enteral Nutrition; HSCT = Haematopoietic Stem Cell Transplantation; N = Number of patients; PN = Parenteral Nutrition