title: Effectiveness of two methods of parenteral nutrition support in improving muscle mass of children with neuroblastoma or Wilms' tumor. A randomized study.
abstract: The short-term and long-term effectiveness of central parenteral nutrition (CPN) versus peripheral parenteral nutrition (PPN) in improving muscle mass (arm muscle area [AMA]) was evaluated for 24 malnourished children with newly diagnosed Stage IV neuroblastoma (n = 14) or Stages II-V Wilms' tumor (n = 10). Patients were randomized to either CPN or PPN plus enteral nutrition (EN: intense nutrition counseling, oral foods, and supplements) for 4 weeks followed by EN until week 10. Oncologic treatment was similar for each tumor type. Dietary, anthropometric, and biochemical measurements were obtained at weeks 0, 4, and 10. During weeks 1 through 4, energy (CPN: means 100 +/- 4; PPN: means 96 +/- 4% of healthy children) and protein (CPN: means 2.5 +/- 0.1; PPN means 2.7 +/- 0.2 g/kg) intakes of the two groups did not differ. The AMA increased (P less than 0.05) with 4 weeks of CPN but not with PPN; changes thereafter with EN were not significant. Weight (P less than 0.05) and triceps skinfolds (P less than 0.01) increased with 4 weeks of PN in both groups and decreased with EN thereafter (P less than 0.01) but were higher at week 10 than diagnosis. Increases in albumin in both groups reached significance at week 10 (P less than 0.05). These data show that CPN improves AMA in malnourished children with neuroblastoma or Wilms' tumor when energy and protein intakes are adequate. The AMA gains can be maintained thereafter with EN.
authors.affiliation: Department of Pediatric Nutrition and Dietetics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis 46223.
authors.forename: K A
authors.initials: KA
authors.lastname: Rickard
authors.forename: M C
authors.initials: MC
authors.lastname: Becker
authors.forename: E
authors.initials: E
authors.lastname: Loghmani
authors.forename: J L
authors.initials: JL
authors.lastname: Grosfeld
authors.forename: B J
authors.initials: BJ
authors.lastname: Godshall
authors.forename: R M
authors.initials: RM
authors.lastname: Weetman
authors.forename: T D
authors.initials: TD
authors.lastname: Coates
authors.forename: C D
authors.initials: CD
authors.lastname: Lingard
authors.forename: N M
authors.initials: NM
authors.lastname: White
authors.forename: B B
authors.initials: BB
authors.lastname: Foland
mesh_terms: D000886:Anthropometry; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D009132:Muscles / Q000473:pathology*; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000150:complications / Q000628:therapy*; D009748:Nutrition Disorders / Q000209:etiology / Q000628:therapy*; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D009396:Wilms Tumor / Q000150:complications / Q000628:therapy*