Enteral nutrition protects children undergoing allogeneic hematopoietic stem cell transplantation from blood stream infections

Enteral Nutrition (EN) is recommended as first line nutritional support for patients undergoing Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT), but only few studies exist in the literature which compare EN to Parenteral Nutrition (PN) in the paediatric population. Forty-two consecutive paediatric patients undergoing allo-HSCT at our referral centre between January 2016 and July 2019 were evaluated. Post-transplant and nutritional outcomes of patients receiving EN for more than 7 days (EN group, n = 14) were compared with those of patients receiving EN for fewer than 7 days or receiving only PN (PN group, n = 28). In the EN group, a reduced incidence of Blood Stream Infections (BSI) was observed (p = 0.02) (n = 2 vs. n = 15; 14.3% vs. 53.6%). The type of nutritional support was also the only variable independently associated with BSI in the multivariate analysis (p = 0.03). Platelet engraftment was shorter in the PN group than in the EN group for a threshold of > 20*109/L (p = 0.04) (23.1 vs 35.7 days), but this correlation was not confirmed with a threshold of > 50*109/L. The Body Mass Index (BMI) and the BMI Z-score were no different in the two groups from admission to discharge. Our results highlight that EN is a feasible and nutritionally adequate method of nutritional support for children undergoing allo-HSCT in line with the present literature. Future functional studies are needed to better address the hypothesis that greater intestinal eubyosis maintained with EN may explain the observed reduction in BSI

Nutritional goals and requirements

The chapter describes current nutritional goals and requirements in health and disease (enteral and parenteral) covering the needs of premature, infants, children, and adults

Enteral nutrition

The chapter describes the principles of enteral nutrition and its applications in pediatrics

A rare case of solid pseudopapillary tumor of the pancreas in a young girl with celiac disease

association between a rare benign tumor of the pancreas and celiac disease in a young girl

Distribution of phytosterols in plasma and liver of rats nourished by different routes and effects on liver function

Phytosterols may lead to parenteral nutrition-associated cholestasis. We planned this study to quantify plasma and liver phytosterols and relate them to liver histology in rats receiving different lipid emulsions. Plasma phytosterols were quantified by gas chromatography-mass spectrometry in 30 inbred rats divided into 6 groups receiving total parenteral nutrition with soybean oil, soy+glutamine, olive oil, structured triglycerides, soy enteral formula, or chow. Hepatic phytosterols and cholesterol oxidation products were determined by gas chromatography-flame ionization. Data were related to liver histology. Groups on total parenteral nutrition with soy and olive oil had the highest plasma sitosterol levels, while those receiving soy or soy+glutamine had more stigmasterol (p=0.0013). These last 2 groups stored high quantities of hepatic campesterol, sitosterol, and stigmasterol. Hepatic cholesterol oxidation products, similarly represented across groups, tripled in rats receiving structured triglycerides. Across groups, liver specimens were normal. Phytosterols seem to accumulate more in the liver, particularly in rats on total parenteral nutrition with soy or soy+glutamine. However, the liver was not damaged by short-term infusion of different phytosterols. It may be that free movement and the lack of lipophilic drugs protected the animals