Outcomes of the implementation of an enteral nutrition algorithm in children and adolescents with cancer
Keywords:
Algorithm, Neoplasms, Enteral nutrition, Nutritional supportAbstract
Objective
This study aimed to describe the algorithm and the global results after its implementation.
Methods
This was a randomized clinical trial done with malnourished cancer patients. Follow-up followed an algorithm and patients with mild malnutrition were randomized to receive store-bought or homemade oral supplementation. The patients were reassessed after three, eight and twelve weeks. Depending on how the group supplemented with store-bought supplements responded, the supplementation was either continued orally, by tube-feeding or discontinued. The group receiving homemade supplementation either continued on it if the response was positive or received store-bought oral supplementation if the response was negative. The
severely malnourished patients either received store-bought supplementation by feeding tube or orally, or it was discontinued if an adequate nutritional status was reached. The patients’ responses to supplementation were determined by weight-for-height Z-scores, body mass indices, triceps skinfold thicknesses and circumferences.
Results
One hundred and seventeen out of 141 patients completed the first three weeks; 58 were severely malnourished and 59 were mildly malnourished. The nutritional status of 41% of the severely malnourished patients and 97% of the mildly malnourished patients receiving store-bought supplement orally improved. The nutritional status of 77% of the mildly malnourished patients receiving homemade supplement orally also improved. Of the 117 patients, 42 had to be tube-fed; of these, 23 accepted and 19 refused tube feeding and continued taking store-bought supplement orally. Consumption of store-bought supplement was higher in tube-fed
patients than in orally-fed patients. Consumption also increased as orally-fed patients became tube-fed. Store-bought supplements given by tube improved nutritional status, showing a positive association between duration of tube feeding and nutritional status.
Conclusion
Store-bought oral supplements improved the nutrient intake of malnourished patients, especially those who were mildly malnourished. The results also suggest that store-bought supplements given by tube improve nutritional status, especially as duration of tube feeding increases.
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Copyright (c) 2023 Adriana GARÓFOLO, Priscila Santos MAIA, Antonio Sérgio PETRILLI, Fábio ANCONA-LOPEZ
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