title: Association between the change in nutritional status in response to tube feeding and the occurrence of infections in children with a solid tumor.
abstract: In 32 children with a solid tumor, the association between the change in weight for height, in response to 4 weeks of tube feeding during the intensive phase of treatment, and the occurrence of leukopenia, leukopenic infections, and nonleukopenic infections in a period thereafter (4-10 weeks) was studied. Factors possibly influencing the change in weight for height during the first 4 weeks of tube feeding were also assessed. A statistically significant negative correlation (rho = -0.59; p < .001) was found between the change in z-score of weight for height in response to the first 4 weeks of tube feeding, and the occurrence of nonleukopenic infections between 4 and 10 weeks. A reduced occurrence of nonleukopenic infections resulted in a significant reduction of the number of days of infection-related hospital admission (rho = .45; p = .009), which, besides providing advantages for the patient, also had economical benefits. The change in weight for height in response to tube feeding was mainly influenced by the incidence of therapy-induced vomiting (r = -.45; p = .02) and by the amount of energy provided by tube feeding (r = .47; p = .007). Based on these findings, it is recommended that naso-gastric tube feeding be used in children with a solid tumor during the early intensive phase of treatment, and that one should aim for a considerable increase in weight for height during the first 4 weeks of administration, since this has been shown to reduce the number of nonleukopenic infections in a subsequent period. The increase in weight for height may be improved by providing an optimal antiemetic protocol, which will increase energy uptake, and an energy-enriched formula, which will increase energy intake.
authors.affiliation: Department of Paediatrics, University Hospital Nijmegen, The Netherlands. E.denBroeder@ckskg.azn.nl
authors.forename: E
authors.initials: E
authors.lastname: den Broeder
authors.forename: R J
authors.initials: RJ
authors.lastname: Lippens
authors.forename: M A
authors.initials: MA
authors.lastname: van't Hof
authors.forename: J J
authors.initials: JJ
authors.lastname: Tolboom
authors.forename: R C
authors.initials: RC
authors.lastname: Sengers
authors.forename: W A
authors.initials: WA
authors.lastname: van Staveren
mesh_terms: D000293:Adolescent; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002648:Child; D015362:Child Nutrition Disorders / Q000150:complications / Q000209:etiology / Q000628:therapy; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007239:Infections / Q000209:etiology*; D007970:Leukopenia / Q000150:complications; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D009752:Nutritional Status; D011446:Prospective Studies; D012189:Retrospective Studies