Abstract
BackgroundChildren undergoing bone marrow transplant (BMT) are at high risk of malnutrition from the side effects of conditioning. Guidelines recommend enteral nutrition first-line with nasogastric tubes the mainstay for provision. Gastrostomies provide an alternative, yet there is limited evidence of their efficacy and safety in BMT. This study aimed to compare feeding tube complications and nutritional outcomes between children fed via gastrostomy versus nasogastric tube during BMT.MethodsA prospective cohort study was conducted at a single UK centre. Children undergoing allogeneic BMT were included. Those receiving CAR-T or first-line parenteral nutrition were excluded. Recruitment ran from April 2021 to April 2022. Tube complications and outcomes were compared between children who used a gastrostomy versus nasogastric tube, from admission to six weeks post-BMT. Data were collected weekly from electronic patient records.ResultsNineteen children comprised the nasogastric group, 24 the gastrostomy (88% recruitment rate). Children were comparable at baseline. In weeks four and six, more children with a nasogastric versus gastrostomy tube developed a tube complication (47.4% v 8.3%, P=0.005; 47.1% v 11.5%, P=0.014 respectively). Major gastrostomy complications comprised 0-20% of episodes each week, minor 80-100%. Inflammation was the most common gastrostomy complication (26.5% of episodes), being pulled out the most common nasogastric (54.7%). No differences were seen in use of parenteral nutrition, weight and mid-upper arm circumference changes between groups, but BMI decreased more in the gastrostomy group from baseline to week four (P=0.007).ConclusionGastrostomy feeding is relatively safe in BMT. Complications occurred frequently but were mostly minor and occurred in similar frequency to nasogastric tubes. Similar efficacy was found between both tubes on various nutritional outcomes. The decision to place a gastrostomy requires careful consideration of the risks, benefits and family preferences. Longer-term follow up and qualitative exploration of family experiences of tube feeding is needed.