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. Author manuscript; available in PMC: 2013 Dec 15.
Published in final edited form as: Pediatr Blood Cancer. 2012 Sep 4;59(7):1160–1167. doi: 10.1002/pbc.24272

Table III.

Indications, Advantages, and Disadvantages of Oral, Nasogastric, Gastrostomy, and Parenteral Nutritional Interventions for Children with Cancer

Indications Advantages Disadvantages
Oral feeding

  • Meeting >90%–100% of estimated energy needs

  • Stable or improving nutritional status

  • Physiologic

  • Noninvasive
Nasogastric (NG) tube feeding

  • Weight loss or inability to meet >90% of energy requirements for 3–5 d

  • Severe mucositis for <3 d

  • Normal gastric emptying

  • Easy tube insertion

  • Larger reservoir capacity in stomach

  • Risk of pulmonary aspiration

  • Cosmetically unappealing

  • Discomfort in nose/pharynx

  • Displacement with emesis

  • Risk of vancomycin-resistant enterococcus (VRE) colonization100
Gastrostomy or jejunostomy feeding

  • Weight loss or inability to meet >90% of energy needs through NG tube for 3–5 d

  • Severe mucositis and/or emesis anticipated

  • Undergoing head/neck radiotherapy

  • Swallowing dysfunction

  • Prolonged dependence on enteral feeding

  • Unwilling to accept NG tube

  • Older patients who would prefer this route

 In comparison with parenteral nutrition54

  • Better maintenance of structural and functional integrity of intestinal tract

  • Lower risk of bacterial translocation

  • Greater ease and safety of administration

  • More physiologic and efficient use of nutrient substrates

  • Lower risk of hepatobiliary complications

  • Increased cost-effectiveness

  • Local irritation

  • Peristomal infection

  • Gastric leakage

  • Tube migration

  • Potential fistula after tube removal

  • Surgery needed for surgical gastrostomies

  • Risk of VRE colonization100
Parenteral nutrition

  • Compromised gastrointestinal absorption and/or unable to tolerate enteral feeds for >3–5 d

  • Severe vomiting and diarrhea

  • Severe pancreatitis

  • Graft vs. host disease affecting the intestinal tract

  • Paralytic ileus

  • Bypasses compromised gastrointestinal tract

  • Does not require direct accessibility to gastrointestinal tract

  • Risk of septic complications

  • Mechanical complications of catheter placement

  • Hemodynamic abnormalities

  • Metabolic and electrolyte abnormalities

  • Hepatobiliary complications

  • Metabolic bone disease