Nutritional support in pediatric patients undergoing bone marrow transplantation.

BACKGROUND: Children undergoing bone marrow transplantation (BMT) are prone to develop severe gastrointestinal (GI) complications and metabolic imbalance which consequently impair their nutritional status. Nutritional support is an important adjunctive treatment during BMT. OBJECTIVE: To assess GI complications, metabolic complications and nutritional outcome of children undergoing BMT with nutritional support intervention. METHOD: Retrospective study of 20 children (median age 6.8 years, 11 males) undergoing BMT at Ramathibodi Hospital from March 1995 to July 2000 was conducted. Their medical records were reviewed. RESULTS: The patients underwent autologous (n = 9) and allogenic BMT (n = 11). Median z-scores of weight for age, height for age and weight for height were 0.06 +/- 1.93, -0.55 +/- 1.18 and 0.48 +/- 1.94, respectively. Nineteen patients had vomiting for 9.8 +/- 5.5 days. Eighteen patients developed diarrhea for 9.6 +/- 7.2 days. The durations of vomiting and diarrhea, as a percentage of total hospital days, were 33.5 +/- 16.3 per cent and 30.4 +/- 17.0 per cent, respectively. There were no differences between the patients with autologous and allogenic BMT regarding these durations. All patients needed enteral and/or parenteral nutrition support for 21.0 +/- 7.7 days except for one patient who could take adequate oral intake. The duration of enteral nutrition support was not significantly different between the groups but the duration of parenteral nutrition support was significantly longer in the allogenic group. Metabolic complications were hypokalemia, hypophosphatemia and one case of arrhythmia secondary to hypomagnesemia. All patients developed febrile neutropenia but none developed catheter-related sepsis. The length of hospital stay was 30.5 +/- 10.2 days. The median z-score of weight for height on the day of discharge was 1.08 +/- 2.03. CONCLUSION: Children undergoing BMT usually have GI symptoms of vomiting, diarrhea and mucositis as well as metabolic imbalances such as hypokalemia, hypophosphatemia and hypomagnesemia. Despite these complications, their nutritional status could be restored by proper nutritional support.

Effect of bifidobacterium Bb12 with or without Streptococcus thermophilus supplemented formula on nutritional status.

Acute diarrhea is a common cause of infant morbidity and mortality. Probiotic supplemented infant formula is one of the effective methods for prevention of rotavirus diarrhea. Other benefits of the probiotics supplemented formula were evaluated by monitoring the growth of the children. A double-blind, placebo-controlled trial was done in 148 children aged 6-36 months. They were divided into 3 groups: the Bb12 group, 51 children received infant formula with Bifidobacteria Bb12 supplement; the Bb12+ST group, 54 children received infant formula with Bb12 and Streptococcus thermophilus supplement; and the control group, 43 children received infant formula without supplement. The mean weight Z-score according to WHO reference standard of the Bbl2 group was -1.8 +/- 0.12, the Bb12+ST group was -1.4 +/- 0.11 and the control group was -1.8 +/- 0.13 at entry. The mean weight Z-score of children after 6 month showed that the children in the Bbl2+ST group had the highest increase in weight which was increased from -1.4 +/- 0.11 to -0.9 +/- 0.12 compared to the Z-score of the Bb12 group which had increased from -1.8 +/- 0.12 to -1.2 +/- 0.13 and in the control group from -1.8 +/- 0.13 to -1.7 +/- 0.25. In terms of the mean height Z-score, the Bb12 group was -2.7 +/- 0.14 to -1.7 +/- 0.16 which was higher than the Bb12+ST group (- 2.2 +/- 0.13 to -1.7 +/- 0.13) but was not different from the control group. However, the mean weight/height Z-score of the Bbl2+ST group had approached the reference standard (Bb12 group -0.1 +/- 0.11 to -0.1 +/- 0.13, Bb12+ST group -0.1 +/- 0.10 to 0.3 +/- 0.17, control group -0.4 +/- 0.12 to -0.1 +/- 0.16). Data showed that children who received the probiotics supplement formula had better growth during the 6 month period.