P4.03: the Role of Parenteral Nutrition in Children after Bone Marrow Transplantation

Background: The first successful bone marrow transplant (BMT) in a child was carried out in 1968. Since then it has become an established therapy for a variety of childhood conditions including malignancies not responding to chemotherapy or radiation, congenital immunodeficiencies and haemoglobinopathies. Complications are common and include graft versus host disease (GVHD), graft failure or rejection, veno occlusive disease and malnutrition. Parenteral nutrition (PN) is used for gut sterilisation in the conditioning phase and offered to children with severe mucositis and GVHD of the gut following transplant and as part of the standard protocol for cord transplant. Methods: Patients undergoing BMT in a large nationally commissioned referral centre were identified from the patient data base between January 2014 and May 2018. Underlying pathology, date and type of BMT, number, age, sex and outcome of children requiring PN for less or more than 28 days and those referred for home PN were recorded. Results: 254 (152 males and 102 females) children underwent a BMT during the study period, 64 patients received PN for less than 28 days of which 9 died. PN was required for more than 28 days in 125 of which 41 died. 15 children were discharged on home PN. The indications were chronic GVHD in 9 and colitis or enteropathy in 6.Four children passed away during this period; one from line sepsis and one each due to pulmonary hypertension, lung GVHD and intracranial relapse of leukaemia. 5 children were successfully weaned off intravenous nutrition and 6 remain on home PN. Conclusion: The majority of children undergoing BMT requires PN. Long term PN > 28 days is common and a small percentage of patients will need home PN. Although home PN improves the overall outcome the mortality rate amongst those patients is high.