Aktuelle Ernährungsmedizin 2005; 30(3): 124-129
DOI: 10.1055/s-2005-866833
Originalbeitrag
© Georg Thieme Verlag KG Stuttgart · New York

Wann ist eine Ernährungstherapie bei krebskranken Kindern sinnvoll?

When to Start Nutritional Support in Children with Cancer?I.  Schmid1 , M.  Streiter1 , M.  Schmitt1 , D.  Stachel2
  • 1Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München
  • 2Universitätsklinik für Kinder und Jugendliche, Erlangen
Manuskript nach einem Vortrag bei dem 22. Gemeinsamen Kongress von DGEM, AKE und GESKES ernährung 2004 in München vom 6. - 8.6.2004
Further Information

Publication History

Publication Date:
13 May 2005 (online)

Zusammenfassung

In der pädiatrischen Onkologie in Deutschland gibt es kein standardisiertes Vorgehen, wann eine Ernährungstherapie bei krebskranken Kindern sinnvoll ist. Es ist ein Algorithmus notwendig, nach dem sich die Zentren richten können. Die Diagnose einer Krebserkrankung im Kindesalter erfolgt in der Regel zu einem Zeitpunkt, zu dem noch kein Gewichtsverlust eingetreten ist. Während der Chemotherapie nimmt bei einigen Kindern mit soliden Tumoren das Körpergewicht ab, nicht bei Kindern mit akuter lymphatischer Leukämie. Eine schwere Mangelernährung liegt vor, wenn das aktuelle Körpergewicht bezogen auf das Längensollkörpergewicht unter 80 % liegt, ein Gewichtsverlust innerhalb eines Monats von mehr als 10 % aufgetreten ist, ein Abfall der Gewichtsperzentile um mehr als 2 Perzentilenkurven und/oder Armanthropometriewerte unter der 5. Perzentile liegen. Bei intaktem Gastrointestinaltrakt und geplanter Ernährungstherapie für weniger als 3 Monate erfolgt eine enterale Therapie über Magensonde, ansonsten über eine Gastrostomie. Bei nicht intaktem Gastrointestinaltrakt und einer über mindestens 7 Tage benötigten Ernährungstherapie wird mit parenteraler Therapie begonnen. Wird der Patient eine Ernährungstherapie für weniger als 7 Tage benötigen, erfolgen Kontrollen.

Abstract

In paediatric oncology in Germany there are no standardised criteria when to use nutrition support. Therefore an algorithm for nutritional support is necessary. Malignant diseases in childhood are usually diagnosed when no weight loss has occurred. During chemotherapy however some of the children with solid tumours loose weight, however not children with acute lymphoblastic leukaemia. Severe malnutrition is present when the following symptoms are present: actual body weight (as % of the body weight belonging to the actual body length) less than 80 %, weight loss of more than 10 % within 1 month, loss of two percentiles of body weight and TSF and MUAC < 5th percentile. If the gastrointestinal tract is normal, special nutrition therapy will be given enterally. A nasogastric tube will be used when therapy is needed for less than 3 months and a gastrostomy when therapy is needed for more than 3 months. If the gastrointestinal tract is not normal and the patient will need nutrition therapy for more than 7 days, parenteral nutrition will be started as soon as possible. If the patient needs nutrition therapy for less than 7 days, there will be controls. Nutritional intervention will be started whenever necessary.

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Dr. med. Irene Schmid

Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital · Ludwig-Maximilians-Universität München

Lindwurmstraße 4

80337 München

Email: Irene.Schmid@med.uni-muenchen.de

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