The role of nutritional intervention in children with nephroblastoma

Abstract

Objective: To assess the effect of nutritional support on the nutritional status of hospitalised children with nephroblastoma. Design: A retrospective, descriptive study. Setting: A tertiary academic hospital in Durban, KwaZulu-Natal. Outcome measure: Changes in weight with oral nutritional supplementation or nasogastric tube feeding. Results: Complete data were available for 37 patients with a median age of 47.5 months and a median hospital stay of 7 months. Seventeen patients (45%) were malnourished on admission. All 37 patients received oral nutritional supplements in the form of additional snacks and oral nutritional drinks, and they had a significant median weight gain of 1.46 kg (–1.95 to 7.20 kg) during the period of study, which significantly exceeded the expected median weight gain of 342 g (p<0.01, Wilcoxon signed ranks test). Seventeen patients (45%) received nasogastric (NG) feeds at some stage of their treatment. Patients were selected for tube feeding based on the clinicians’ assessment of their clinical features and anthropometry and ability to tolerate oral feeding. Despite their more severe clinical diathesis, they gained as much weight as those not receiving nasogastric feeding. (p=0.20; Mann-Whitney U-test). Twenty-two patients (58%) received Filgastrim. Overall, patients on Filgastrim gained less weight than those not receiving Filgastrim (p=0.04; Mann-Whitney U-test). Twenty-five patients (66%) received radiotherapy. Radiotherapy did not independently influence the change in weight (p=0.15, Mann-Whitney U-test). Conclusion: With aggressive nutritional support, patients being treated for nephroblastoma gained more weight over the treatment period than accounted for by normal expected growth. Chemotoxicity was shown to have a negative effect on weight gain. Such patients, and those with pre-existing malnutrition, should in future be targeted to receive nasogastric feeds. Despite this being a retrospective descriptive study, with clear limitations and incomplete data, it suggests that early and continuous aggressive nutritional assessments and support are beneficial.