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Feeding patterns and outcomes of enterally tube fed paediatric kidney transplant recipients

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Abstract

Objective

Many children with chronic kidney disease (CKD) exhibiting symptoms of poor appetite, gastro-oesophageal reflux and vomiting are reliant on enteral tube feeds (ETF) to achieve adequate nutritional intake. Following a successful renal transplant (RT), some of these symptoms may resolve and ETF then discontinued. There are only a few studies reporting the time taken to transition from ETF to complete oral feeding after transplantation. This study aimed to investigate the time taken to discontinue ETF following RT in children attending a large tertiary nephrology unit.

Methods

A retrospective review of medical and dietetic records between 1 January 2014 and 31 December 2017.

Results

The study included 20 paediatric renal transplant recipients (70% male) aged 1 to 17 years. Seventy percent discontinued ETF at a median of 6 (0–70) weeks post-transplantation. Patients had ETF from a median of 0.45 (0–10.8) years of age, for a median of 3.9 (1.1–10.9) years prior to receiving a transplant. Four (20%) were referred to the Feeding and Eating Disorder team at a median of 20 (2–44) months post-renal transplantation. Mean body mass index (BMI) Z-score of 0.43 at 12 months pre-transplant was found to be significantly associated with shorter duration of ETF post-transplant (r = 0.8, p = 0.001).

Conclusions

Seventy percent of children stopped ETF by a median of 6 weeks post-renal transplant. A good nutritional status pre-transplant may reduce the duration of ETF following transplantation. Four children experienced behavioural feeding issues post-transplant and required further specialist support. Future multi-centre research is required to support these findings to provide a more robust indication of time to achieve full oral feeding.

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Acknowledgements

The authors would like to thank the following: the University of Plymouth as this was submitted as my Masters dissertation, Anne Payne who was my academic supervisor and provided guidance during the write up of my study, Vanessa Shaw for her invaluable guidance and knowledge within this field.

Funding

This project was financially supported by the National Institute for Health Research (NIHR) Biomedical Research Centres based at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Author information

Authors and Affiliations

  1. Dietetics Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

    Sarah Khweir & Louise McAlister

  2. School of Health Professions (Faculty of Health and Human Sciences), University of Plymouth, Plymouth, UK

    Sarah Khweir

  3. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

    Stephen D Marks

  4. University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK

    Stephen D Marks

Authors
  1. Sarah Khweir
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  2. Louise McAlister
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  3. Stephen D Marks
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Corresponding author

Correspondence to Sarah Khweir.

Ethics declarations

This retrospective service evaluation was registered with the NHS Trust clinical audit and service evaluation team. The researcher also completed an ethics form via the Faculty of Health and Human Sciences Health Student Research Ethics Subcommittee at the University of Plymouth as part of their university project. There was no ethical risk as only routinely collected data was used and no additional information was collected outside of the patients’ health records.

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The authors declare that they have no conflict of interest.

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Khweir, S., McAlister, L. & Marks, S.D. Feeding patterns and outcomes of enterally tube fed paediatric kidney transplant recipients. Pediatr Nephrol 35, 2361–2367 (2020). https://doi.org/10.1007/s00467-020-04618-z

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  • DOI: https://doi.org/10.1007/s00467-020-04618-z

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