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Effects of Parenteral Nutrition in Pediatric Patients with Hematopoietic Stem Cell Transplantation
조혈모세포이식을 시행한 소아 환자에서 정맥영양의 유효성 평가
J Clin Nutr 2018;10:9-19
Published online June 30, 2018
© 2018 Korean Society for Parenteral and Enteral Nutrition.

Soo Young Lim1, Min Jae Jung1,2, Ji Eun Park1,2, Jae Song Kim1, Soo Hyun Kim1, Chuhl Joo Lyu3, Eun Sun Son1
임수영1, 정민재1,2, 박지은1,2, 김재송1, 김수현1, 유철주3, 손은선1

1Department of Pharmacy, 2Pediatric Nutrition Support Team, 3Department of Pediatric Hematology Oncology, Severance Hospital, Yonsei University Health System, Seoul, Korea
연세대학교의료원 세브란스병원 1약무국, 2소아영양집중지원팀, 3소아혈액종양과
Eun Sun Son
Department of Pharmacy, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-6896, Fax: +82-2-2227-7983, E-mail: SESPHARM@yuhs.ac
Received January 31, 2018; Revised February 22, 2018; Accepted February 24, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: This study examined the effects of parenteral nutrition (PN) on the nutritional status, clinical improvement, and PN-related complications in pediatric patients who had undergone hematopoietic stem cell transplantation (HSCT).
Methods: A retrospective audit of 110 pediatric patients (age≤18), who underwent HSCT from March 2015 to February 2017 was undertaken. The patients were divided into 3 groups based on the ratio of daily calorie supplementation to the daily calorie requirement (ROCS). The clinical factors related to the nutritional status, such as difference in body weight (BW), body mass index (BMI), percent ideal body weight (PIBW), total protein (T.protein), and albumin; the early clinical outcome, such as PN-duration, length of hospitaliaztion (LOH), engraftment day (ED), graft-versus-host disease, sepsis, pneumonia and mucositis; and PN-related complications, including elevation of total bilirubin (T.bil), direct bilirubin (D.bil), aspartate aminotransferase, alanine aminotransferase, glucose and cholesterol levels, and hepatic veno-occlusive disease were analyzed using the electronic medical records. Additional analysis subject to auto-HSCT and allo-HSCT patients was also performed.
Results: The very-low-ROCS, low-ROCS, and satisfied-ROCS group were 30 (27.3%), 47 (42.7%), and 33 (30.0%) patients, respectively. The PN-duration (P=0.005, z=–2.271), LOH (P=0.023, z=–2.840), ED (P<0.001, z=–3.695), T.bil elevation (P<0.001, z=–3.660), and D.bil elevation (P=0.002, z=–3.064) tended to decrease with increasing ROCS. The difference in the PN-duration (P=0.017), ED (P=0.001), T.bil elevation (P=0.001), and D.bil elevation (P=0.011) in the 3 groups was statistically significant. In the auto-HSCT patients, the change in BW (P=0.031, z=+2.154), PIBW (P=0.029, z=+2.187), and BMI (P=0.021, z=+2.306) tended to increase. In the allo-HSCT patients, the change in T.protein (P=0.022, z=+2.286) increased but the ED (P=0.021, z=–2.304) decreased.
Conclusion: Aggressive PN supplementation has an effect on maintaining the nutritional status and achieving better early outcomes in pediatric HSCT patients, whereas it has no effect on increasing the PN-related complications.
Keywords : Hematopoietic stem cell transplantation, Parenteral nutrition, Pediatrics

 

June 2018, 10 (1)