Title: Considerations for Preserving Gastrointestinal Function and Preventing Oral Aversion in Pediatric Hematopoietic Stem Cell Transplant Patients
Abstract: The incidence of mucosal barrier injury associated with pediatric hematopoietic stem cell transplant (HSCT) often leads to the necessity of parenteral nutrition (PN) and reestablishment of adequate oral intake. Previous treatment effects may include malnutrition, altered taste sensations and fragile mucosa that may exacerbate during HSCT. Literature reports that long term use of PN may predispose patients to infection, development of gallstones and nutritional alterations post-transplant. Historically, neutropenic/ low bacteria HCST diets has led to altered taste sensations, boredom with food choices and undue family expenses in attempts to purchase likeable foods and frequent use of PN. To mitigate the risks of these adverse effects, improve patient outcomes and experience; an interprofessional BMT team convened and developed a preventative approach. A literature review and national best practices related to HSCT dietary restrictions was completed. The team hypothesized that offering children increased food varieties, eliminating family time and expense and introducing early eating techniques may assist patient's desire for and ease of adequate nutritional intake and reduce the duration of or elimination of PN. The team reviewed the institutional HSCT dietary options and redefined safe food option lists. Nutritional services stocked these items and ensured their availability at stores where families commonly shop once discharged. The department also agreed to purchase requested items from the lists within 24 hours if not in stock. Furthermore, occupational therapy experts implemented a "baby-led weaning" program for younger patients to preserve oral motor skills in hopes of minimizing or preventing oral aversion. Discharge education included focused attention on awareness of ingredients, foods and beverages to avoid that may exacerbate gastrointestinal disturbances post discharge. Pre and Post interventions PN usage will be reviewed. Literature supports that young children who eat a mixture of foods have the greatest nutrient intakes and healthiest diets well into adulthood.