Department of Clinical Nutrition, Division of Oncology, Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Pediatr Blood Cancer. 2014 Feb;61(2):281-5. doi: 10.1002/pbc.24759. Epub 2013 Sep 9.
To determine feasibility and safety of proactive enteral tube feeding (ETF) in pediatric oncology patients.
Pediatric patients with newly diagnosed brain tumors, myeloid leukemia or high-risk solid tumors were eligible. Subjects agreeing to start ETF before cycle 2 chemotherapy were considered proactive participants (PPs). Those who declined could enroll as chart collection receiving nutritional standard of care. Nutritional status was assessed using standard anthropometric measurements. Episodes of infection and toxicity related to ETF were documented from diagnosis to end of therapy. A descriptive comparison between PPs and controls was conducted.
One hundred four eligible patients were identified; 69 enrolled (20 PPs and 49 controls). At diagnosis, 17% of all subjects were underweight and 26% overweight. Barriers to enrollment included physician, subject and/or family refusal, and inability to initiate ETF prior to cycle 2 of chemotherapy. Toxicity of ETF was minimal, but higher percentage of subjects in the proactive group had episodes of infection than controls. Thirty-nine percent of controls eventually started ETF and were twice as likely to receive parenteral nutrition. PPs experienced less weight loss at ETF initiation than controls receiving ETF and were the only group to demonstrate improved nutritional status at end of study.
Proactive ETF is feasible in children with cancer and results in improved nutritional status at end of therapy. Episodes of infection in this study are concerning; therefore, a larger randomized trial is required to further delineate infectious risks and toxicities that may be mitigated by improved nutritional status.
旨在确定在儿科肿瘤患者中主动肠内喂养（ETF）的可行性和安全性。
新诊断为脑肿瘤、髓性白血病或高危实体瘤的儿科患者符合条件。同意在第 2 周期化疗前开始 ETF 的患者被视为主动组（PP）。拒绝的患者可以作为接受营养标准护理的图表收集参与者入组。使用标准人体测量学测量来评估营养状况。从诊断到治疗结束，记录与 ETF 相关的感染和毒性事件。对 PPs 和对照组进行描述性比较。
确定了 104 名符合条件的患者；有 69 名入组（20 名 PPs 和 49 名对照组）。在诊断时，所有患者中有 17%体重不足，26%超重。入组的障碍包括医生、患者和/或家属拒绝以及无法在第 2 周期化疗前开始 ETF。ETF 的毒性很小，但主动组的患者感染发生率高于对照组。对照组中 39%最终开始了 ETF，并且更有可能接受肠外营养。与接受 ETF 的对照组相比，PP 在开始 ETF 时体重减轻较少，并且是唯一一组在研究结束时显示出改善的营养状况的组。
在癌症儿童中，主动 ETF 是可行的，并且在治疗结束时可改善营养状况。本研究中感染的发生率令人担忧；因此，需要进行更大规模的随机试验来进一步阐明可能通过改善营养状况减轻的感染风险和毒性。
