Nutrition 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. Methods An online survey was administered to all 12 centers. The lead dietician answered questions regarding nutritional counselling, screening, assessment, and interventions. Questions regarding current use, perceived advantages, and problems of gastrostomies were answered by the dietician, lead clinical nurse specialist, and physician. Results A 100% response rate was achieved from 12 centers (36/36 clinicians). Nutrition counselling 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 centers used gastrostomies. In those not using them, 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. Risk of surgery (92%) and tube/stoma complications (58%) were the most common perceived problems. Conclusions A similar approach was shown on many aspects of nutrition support. Gastrostomy use divided opinion with differences in use and perceived advantages, but agreement on potential complications. Despite their risks clinicians wanted to utilize gastrostomies more. Placement requires careful consideration of the risks, benefits and family preferences.