Bendelsmith Charles R, Linabery Amy M, Nickel Amanda J, Laquere Rachel M, Ingram Katherine M, Hansen Melissa B, Pape-Blabolil Julie A, Skrypek Mary M, Bendel Anne E
Children's Minnesota Research Institute, Minneapolis, Minnesota.
Nutrition Services, Children's Minnesota, Minneapolis, Minnesota.
Neurooncol Pract. 2020 Jul;7(4):428-438. doi: 10.1093/nop/npaa003. Epub 2020 Feb 7.
Children with high-grade CNS cancers frequently experience malnutrition during treatment. We assessed the effects of proactive enteral tube (ET) placement/enteral tube feedings (ETF) on weight in infants/children with high-grade CNS tumors treated with aggressive chemotherapy.
We conducted a retrospective study of patients age 0 to 19 years treated for new high-grade CNS tumors between 2002 and 2017 at a tertiary pediatric hospital system. Patients underwent placement of proactive ET (≤ 31 days postdiagnosis; n = 45), rescue ET (> 31 days, due to weight loss; n = 9), or no ET (n = 18). Most received surgically placed ET (98%), with percutaneous endoscopic gastrojejunostomy or gastrojejunostomy tubes favored to allow jejunal feeding. The majority of patients with ET used ETF (91%). Using mixed-effects regression models, we examined differences in mean weights between ET/ETF groups across the first year of treatment. We also evaluated observed weight changes.
All infants (n = 22, median age, 1.5 years) had proactive ET placed and 21 of 22 used proactive ETF. Infants showed an initial increase in mean percentage weight change that eventually leveled off, for an estimated increase of 10.4% over the year. For the pediatric cohort (n = 50, median, 8.1 years), those receiving proactive ETF experienced weight increases (+9.9%), those with rescue ETF experienced an initial decline and eventually rebounded for no net change (0.0%), and those with no ETF demonstrated an initial decline that persisted (-11.9%; < .001). Analysis of observed weights revealed nearly identical patterns.
Proactive ETF was effective at maintaining weight and/or facilitating weight gain over the first year of treatment and was acceptable to patients/families.
患有高级别中枢神经系统癌症的儿童在治疗期间经常出现营养不良。我们评估了预防性放置肠内管（ET）/肠内管饲（ETF）对接受积极化疗的高级别中枢神经系统肿瘤婴儿/儿童体重的影响。
我们对2002年至2017年在一家三级儿科医院系统接受新的高级别中枢神经系统肿瘤治疗的0至19岁患者进行了一项回顾性研究。患者接受了预防性ET放置（诊断后≤31天；n = 45）、抢救性ET放置（>31天，因体重减轻；n = 9）或未放置ET（n = 18）。大多数患者接受手术放置的ET（98%），倾向于使用经皮内镜胃空肠造口术或胃空肠造口管以便进行空肠喂养。大多数接受ET的患者使用ETF（91%）。使用混合效应回归模型，我们研究了治疗第一年ET/ETF组之间平均体重的差异。我们还评估了观察到的体重变化。
所有婴儿（n = 22，中位年龄1.5岁）都接受了预防性ET放置，22名婴儿中有21名使用了预防性ETF。婴儿的平均体重变化百分比最初有所增加，最终趋于平稳，估计一年中增加了10.4%。对于儿科队列（n = 50，中位年龄8.1岁），接受预防性ETF的患者体重增加（+9.9%），接受抢救性ETF的患者最初体重下降，最终反弹，体重无净变化（0.0%），而未接受ETF的患者最初体重下降且持续下降（-11.9%；P <.001）。对观察到的体重进行分析发现了几乎相同的模式。
预防性ETF在治疗的第一年有效地维持了体重和/或促进了体重增加，并且患者/家庭可以接受。
