den Broeder E, Lippens R J, van't Hof M A, Tolboom J J, Sengers R C, van Staveren W A
Department of Paediatrics, University Hospital Nijmegen, The Netherlands.
Pediatr Hematol Oncol. 2000 Oct-Nov;17(7):567-75. doi: 10.1080/08880010050122834.
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.
在32名实体瘤患儿中，研究了在治疗强化期进行4周管饲后身高别体重变化与之后一段时间（4 - 10周）白细胞减少、白细胞减少性感染和非白细胞减少性感染发生之间的关联。还评估了可能影响管饲前4周身高别体重变化的因素。发现管饲前4周身高别体重z评分的变化与4至10周非白细胞减少性感染的发生之间存在统计学显著负相关（rho = -0.59；p <.001）。非白细胞减少性感染发生率降低导致感染相关住院天数显著减少（rho =.45；p =.009），这除了对患者有益外，还具有经济效益。管饲引起的身高别体重变化主要受治疗引起的呕吐发生率（r = -.45；p =.02）和管饲提供的能量总量（r =.47；p =.007）影响。基于这些发现，建议在实体瘤患儿治疗的早期强化阶段使用鼻胃管饲，并在给药的前4周内使身高别体重有显著增加，因为这已被证明可减少随后一段时间内非白细胞减少性感染的数量。通过提供最佳的止吐方案（这将增加能量摄取）和富含能量的配方奶（这将增加能量摄入），可改善身高别体重的增加。
