Comparison of Parenteral Nutrition Usage in Pediatric Bone Marrow Transplant Patients with and without Gastrostomy Tubes

Purpose To determine whether placement of gastrostomy tubes (GT) in pediatric bone marrow transplant patients prior to transplant and provision of enteral nutrition (EN) can decrease the duration/necessity of parental nutrition (PN) usage during time of treatment related mucositis and nausea/vomiting. Methods We retrospectively reviewed the medical records of pediatric bone marrow transplant patients admitted to the Medical University of South Carolina (MUSC) Children's Hospital from July 2014 through July 2018. We collected data on type of transplant, chemotherapy regimen, presence of GT, PN initiation and duration, diagnosis of veno-occlusive disease (VOD), and hospital length of stay (LOS). Results We analyzed 63 transplant occurrences in 53 patients including 23 allogeneic, 35 autologous and 5 haplo-identical stem cell transplants. In 28 of 63 (44%) transplant occurrences, the patients had a GT placed prior to admission. PN was administered in 22 of 28 (79%) in the GT group and 28 of 35 (80%) in the no GT group. The average duration of PN was 10 days in the GT group (range 4 to 20 days) and 17 days in the no GT group (range 1 to 65 days). The incidence of VOD was 14% in both GT and no GT groups. The average length of stay was 36 days (range 23 to 59) in the GT group and 44 days (range 23 to 83) in the no GT group. Conclusion Placement of gastrostomy tubes and provision of EN in pediatric bone marrow transplant patients did not eliminate the need for PN but decreased the number of days patients require PN during the transplant process. Our data did not show a decrease in the incidence of VOD in patients with GT. Though many factors play a role, we demonstrated an association between GT placement and decreased length of stay.