RESUMEN
BACKGROUND & AIMS: For children and adolescents undergoing hematopoietic stem cell transplant (HSCT), adequate protein and energy intake is essential to mitigate malnutrition risk. However, little is known about optimal requirements, including adequate dietary protein intake in this population. We conducted an international benchmarking survey and a scoping review to explore current practices in determining protein requirements (PR) and examine existing evidence for PR and dietary protein intake in pediatric HSCT. METHODS: Twelve pediatric oncology centers were surveyed to elicit current practices in determining PR in pediatric HSCT. A scoping review then collected sources of evidence from six databases (MEDLINE, Embase, CINAHL, PubMed, Cochrane Library and Web of Science) and grey literature (Google Scholar). RESULTS: Survey data revealed variable practices in determining PR for pediatric HSCT patients. Four centers (44%) used the American Society for Parenteral and Enteral Nutrition (ASPEN) Nutrition Support in Pediatric Critically Ill Patient Guidelines 2009 and four (44%) used local guidelines or their national nutrient reference values (NRV). The scoping review included nineteen studies. The review highlighted a broad range of PR used in this population, ranging from 0.8 to 3.0 g/kg/d. Practices regarding the documentation and frequency of collecting protein intake data varied. Only five studies reported estimated protein requirement (EPR) status and just two studies met EPR. No clinical guidelines on PR in pediatric HSCT were identified. CONCLUSIONS: Given the existing gap in evidence, the optimal amount of protein required for children and adolescents undergoing HSCT remains unknown. To establish specific, evidence-based PR guidelines, comprehensive research is needed. Future investigations should prioritize evaluating current clinical practices, assessing the gap between actual protein intake and EPR, and understanding the relationship between protein intake, protein status, and the impact on treatment outcomes. Addressing these research priorities is crucial for bridging the current evidence gap, thereby enabling the development of enhanced and personalized nutritional support for children and adolescents undergoing HSCT.
RESUMEN
Nutritional profile and management of patients with primary immunodeficiencies (PID) undergoing hematopoietic stem cell transplant (HSCT) has not been described in the literature. We aim to report the nutritional challenges and practices peculiar to this population before and after HSCT and suggest clinical pathways for their management. We conducted a single-centre retrospective study. Inclusion criteria were children aged less than 20 years with a diagnosis of PID who have undergone HSCT at the Royal Children's Hospital Melbourne since April 2014 with a minimal follow-up of 1 year. Nutritional parameters were collected in the pre-transplant period, at conditioning, and at 1, 3, 6 and 12 months post-HSCT. Descriptive analysis were used. Between April 2014 and December 2018, 27 children received 31 HSCT. Before transplant, 33% had a weight and/or height ≤ -2 standard deviations (SD). Forty percent required nutritional support before transplant: 33% had enteral nutrition (EN) while 7% required long-term parenteral nutrition (PN) due to intestinal failure. After transplant, although most children were started on EN, 82% required PN with a mean duration of 67 days. Mean time to full oral diet was 154 days. Pre-transplant mean weight and height were -0.57 SD and -0.88 SD respectively. After a decrease in anthropometric parameters the first 3 months post-transplant, progressive catch up was noticeable for weight (-0.27 SD) with no catch up for height at 1 year (-0.93 SD). Our work highlights the nutritional challenges and specificities of children with PID in the peri-transplant period. An approach to nutrition assessment and management in the pre- and post-transplant period is proposed.