Nutritional support practices and opinions toward gastrostomy use in pediatric bone marrow transplant centers: A national survey

Abstract

Objective: Previous surveys have shown deviations in nutritional practices from international guidelines during bone marrow transplant (BMT). Guidelines recommend enteral nutrition first-line and nasogastric tubes are the mainstay for its provision. Gastrostomies provide an alternative, yet their use is less common. This national survey investigated nutrition support practices in pediatric allogeneic BMT centers and compared clinicians’ opinions on gastrostomy use. The aim of this study was to identify the national picture of nutritional support practices across pediatric allogeneic BMT centers, including use and opinions of dietitians, clinical nurse specialists, and physicians, toward gastrostomy feeding. Methods: An online survey was administered to 12 centers. The lead dietitian answered questions regarding nutritional counseling, screening, assessment, and interventions. Questions regarding current use, perceived advantages, and problems of gastrostomies were answered by the dietitian, lead clinical nurse specialist, and physician. Results: A 100% response rate was achieved from 12 centers (N = 36 clinicians). Nutritional counseling was provided in 92% of centers before and routinely throughout admission, 83% screened on and regularly throughout admission, 83% assessed nutritional status before transplant, and 92% used enteral nutrition first-line. Forty-two percent of the centers used gastrostomies. In those not using gastrostomies, 76% of clinicians felt some children should be offered a gastrostomy. Clinicians perceived less displacements (78%) and cosmetic appearance (69%) as the most common advantages of gastrostomies over nasogastric tubes. Risks associated with surgery (92%) and tube/stoma complications (58%) were the most common perceived problems. Conclusions: A similar approach was shown on many aspects of nutritional support. Gastrostomy use divided opinion with differences in use and perceived advantages, but agreement on potential complications. Despite their risks, clinicians wanted to use gastrostomies more. Placement requires careful consideration of the risks, benefits, and family preferences.

Publication DOI: https://doi.org/10.1016/j.nut.2021.111556
Divisions: College of Health & Life Sciences > School of Optometry > Optometry
College of Health & Life Sciences
Additional Information: Copyright © 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
Publication ISSN: 1873-1244
Last Modified: 23 May 2024 07:20
Date Deposited: 02 Mar 2023 14:38
Full Text Link:
Related URLs: https://www.sci ... 4184?via%3Dihub (Publisher URL)
PURE Output Type: Article
Published Date: 2022-03
Published Online Date: 2021-11-27
Accepted Date: 2021-11-22
Authors: Evans, James
Green, Daniel (ORCID Profile 0000-0003-1934-6725)
Connor, Graeme O
Lanigan, Julie
Gibson, Faith

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