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Percutaneous endoscopic gastrostomy in children with malignant disease
Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
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2002 (English)In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, Vol. 19, no 5, 154-163 p.Article in journal (Refereed) Published
Abstract [en]

The objective of the study was to assess both the possible complications of percutaneous endoscopic gastrostomy (PEG) in pediatric cancer patients and its effect on weight development. The medical records of 18 children with a median age of 2.5 years (range, 0.5-14.2 years) were reviewed. The diagnoses were leukemia, central nervous system tumors, solid tumors, and lymphoma. The indications for PEG were anticipated therapy-related nutritional problems and inadequate food intake, weight loss, swallowing problems in relation to paresis of the pharynx, and relapse of the disease. Ten children received a PEG at treatment start, and eight children received it at a median time of 3.4 months (range, 0.9-27.4 months) after treatment start. The median duration of having a PEG in place was 12.3 months (range, 1.2-24.0 months). At admission the median weight for age expressed as standard deviation (SD) was -0.11 (range, -2.78-2.68). There was a significant (p =.005) decrease in the median SD from admission until PEG installation. There was also a significant increase in the median SD from the start of PEG use until 1 (p =.04) and 2 (p =.039) months after start. The most common complications were episodes of inflammation of the PEG site, which were successfully treated with topically or orally administered antibiotics, and episodes of infection, which required intravenously administered antibiotics. Taking into consideration the medical condition of the children in the study group and the considerable length of time with a PEG in place, we believe that nutrition via PEG in children with cancer has several advantages and is rarely associated with other than minor complications. Copyright 2002 by Association of Pediatric Oncology Nurses

Place, publisher, year, edition, pages
2002. Vol. 19, no 5, 154-163 p.
URN: urn:nbn:se:umu:diva-4768DOI: 10.1016/S1043-4542(02)00008-5PubMedID: 12244527OAI: diva2:144000
Available from: 2005-10-21 Created: 2005-10-21Bibliographically approved
In thesis
1. Nutritional consequences in children undergoing chemotherapy for malignant disease
Open this publication in new window or tab >>Nutritional consequences in children undergoing chemotherapy for malignant disease
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chemotherapy has side effects that may interfere with food intake. Children suffering from a malignant disease are subjected to treatment with chemotherapy. They may therefore become at risk of undernutrition during the period of treatment. This in turn may increase the risk of infections, delayed therapy and influence the outcome of treatment. Few studies have investigated how children undergoing chemotherapy for cancer perceive food and eating. Attempts to improve food intake and the nutritional status require an understand-ing of how eating patterns are altered during chemotherapy in children.

Study design: Dietary information and anthropometric data were collected after the initiation of chemotherapy in 14 children, consecutively admitted to the Paediatric Haematology and Oncology Unit at Umeå University Hospital. This initial study resulted in the establishment of more flexible mealtime routines on the ward. A follow-up study was conducted with another group of 11 children. Interviews were performed with a third group of 21 consecutively ad-mitted children, their parents and attending nurses. The focus was on the children’s own per-ception of and their parents’ and nurses’ attitudes to their food intake during hospitalisation. Recognition thresholds for the basic tastes were determined with 10 of the oldest of these children and 10 healthy controls.

Results: Before introduction of new mealtime routines, the average daily oral energy intake during hospitalisation was 58% of the Swedish Nutrition Recommendations, SNR. The chil-dren had a significant weight loss up to three months after onset of chemotherapy. After the introduction of new mealtime routines, the average daily oral intake on hospital days was 61% of SNR and thus still lower than recommended despite efforts to serve palatable food on the ward. When enteral and parenteral nutrition was included, the energy intake came close to that recommended for healthy children, 91% of SNR. Both children and parents perceived that altered taste was an important cause of the children’s eating problems. The children also viewed food aversions, nausea and vomiting and pain as important causes, while the parents perceived nausea, food aversions and altered smell as significant factors. The nurses on the other hand, viewed nausea, the ward environment, and food rejection as a way of gaining some influence over the situation as important factors. The patients had significantly higher thresholds for bitter taste and significantly more patients made mistakes in taste recognition compared with controls.

Conclusion and clinical implication: There seem to be changes both in the sense of taste as well as in the perception of food in children undergoing chemotherapy for malignant disease. Thus, single solutions such as providing a variety of “tasty food” in the hospital setting in order to improve food intake does not suffice for many paediatric cancer patients. The indi-vidual’s food preferences and aversions should be considered and combinations of oral, en-teral and parenteral nutrition support should be provided.

Place, publisher, year, edition, pages
Klinisk vetenskap, pediatrik, 2005. 54 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 985
paediatric oncology, chemotherapy, food intake, taste alteration
urn:nbn:se:umu:diva-617 (URN)91-7305-943-9 (ISBN)
Public defence
2005-12-02, sal 135, Allmän medicin, BY 9A, NUS, Umeå, 13:00 (English)
Available from: 2005-10-21 Created: 2005-10-21 Last updated: 2009-11-27Bibliographically approved

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