The Effects of Enteral and Parenteral Nutrition on Pediatric Hematopoietic Stem Cell Transplant Patients: An Integrative Review Restricted; Files Only

Abstract

Children receiving hematopoietic stem cell transplants (HSCT) are at risk for malnutrition which may negatively affect their quality of life. These risks include impaired oral feeding from factors such as pre-transplant conditioning causing vomiting, diarrhea, and mucositis. Enteral nutrition (EN) and parenteral nutrition (PN) are support options for this patient population when oral feeding is impaired. This integrative review will evaluate the literature to determine outcomes of EN and PN in pediatric HSCT patients and implications for practice. Outcomes impacted by EN and PN include platelet and neutrophil engraftment, mucositis, acute graft versus host disease, infection, electrolytes imbalances, weight gain, hospital length of stay, mortality, morbidity, and survival rate. Suggestions for optimizing nutritional support in pediatric HSCT are presented, as well as recommendations for further research.

Table of Contents

Contents

Background 3

Significance 7

Framework 7

Clinical Question and Purpose 12

Literature Review and Synthesis 12

Methods 12

Design 12

Inclusion and Exclusion Criteria 13

Population, Sample, and Setting 15

Barriers 15

Project Management Plan 15

Resources, Key Stakeholders, and Site Support 16

Plan for Dissemination to Key Stakeholders 16

Results 17

Clinical Outcome of EN and PN 18

Engraftment 18

Mucositis 19

Graft Versus Host Disease 21

Potential Complications 23

Infection 23

Electrolyte Imbalance 24

Tube Placement Issues 25

Weight Gain 25

Overall Hospital and Survival Outcomes 26

Implementation Case Study 27

Discussion 27

Implications and Recommendations for Practice 29

Limitations 30

Conclusion 30

Evaluation of Process and Experience 31

References 32

Appendix A 39

Appendix B 54

About this Scholarly Project

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Nell Hodgson Woodruff School of Nursing
Specialty	Pediatric Acute Care Nursing Practice
Degree	D.N.P.
Submission	Scholarly Project
Language	English
Research Field	Health Sciences, Nursing Health Sciences, Nutrition Health Sciences, General
关键词	Enteral nutrition Pediatric Parenteral nutrtition Hematopoietic stem cell transplant
Committee Chair / Thesis Advisor	Calamaro, Christina, Emory University
Committee Members	Brown, Ann-Marie, Emory University Cherven, Brooke, Emory University

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