Attenuation of resting energy expenditure following hematopoietic stem cell transplantation in children

BACKGROUND: Children undergoing hematopoietic stem cell transplantation (HSCT) typically receive parenteral nutrition (PN) due to gastrointestinal toxicities. Accurate determination of resting energy expenditure (REE) may facilitate optimal energy provision and help avoid unintended overfeeding or underfeeding. METHODS: In a multicenter, prospective cohort study of children undergoing allogeneic HSCT, REE was measured by indirect calorimetry at baseline and twice weekly until 30 days after transplantation. Change in percent predicted REE over time from admission was analyzed using repeated measures regression analysis. RESULTS: Twenty-six children (14 females) with a mean (SD) age of 14.9 (4.2) years who underwent an HLA-matched sibling or unrelated donor transplantation were enrolled. Mean (SD) percent predicted REE at baseline was 92.4 (15.2). Baseline REE was highly correlated with lean body mass measured by DXA (r=0.78, p<.0001). REE decreased significantly over time, following a quadratic curve to a nadir of 79% predicted at 14 days post transplantation (p <0.001) and returned to near baseline by day 30. CONCLUSIONS: Children undergoing HSCT exhibit a significant reduction in REE in the early weeks after transplantation, a phenomenon that places them at risk for overfeeding. Serial measurements of REE or reductions in energy intake should be considered when PN is the primary mode of nutrition.