Effects of naso-gastric tube feeding on the nutritional status of children with cancer

Objective: To study the effect of sufficient energy intake, by means of the protocolized administration of nasogastric tube feeding, on the nutritional status of a child with cancer. Design: A comparative experimental study. Setting: Tertiary care at the Centre for Pediatric Oncology, South East Netherlands, University Hospital, Nijmegen. Subjects: Seven children, newly diagnosed with cancer, were included in the experimental study and all completed the trial period. Fourteen patients were included in the retrospective study. They were randomly chosen from a group of patients previously treated for a malignancy at our department and who had received naso-gastric tube feeding for at least 16 weeks. Intervention: Protocolized (experimental group) vs non-protocolized (retrospective group) administration of naso-gastric tube feeding over a period of 16 weeks. The main difference was the amount of tube feeding administered. In addition to energy from other foods, children in the experimental group received 106 +/- 13% of their total dairy energy requirements (TDER) by means of tube feeding, whereas children in the retrospective group had received 75 +/- 24%. Main outcome measures: Weight as a percentage of weight for height according to the 50th percentile of a healthy reference population = ideal weight. Results: Weight, expressed as a percentage of the ideal weight, increased significantly in the experimental group (18.2 +/- 8.4; P = 0.01) and the retrospective study group (5.2 +/- 7.3; P = 0.001). However, the increase was statistically significant in favour of the experimental group (P = 0.003), in which all the children reached their ideal weight, compared to 21% in the retrospective group. Conclusion: Aggressive protocolized nutritional intervention during the intensive phase of anti-cancer treatment, in the form of naso-gastric tube feeding that provides the child's total daily energy requirements, results in considerable improvement in the nutritional status.