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A randomized trial of the effectiveness of the neutropenic diet versus food safety guidelines on infection rate in pediatric oncology patients
Author(s) -
Moody Karen M.,
Baker Rebecca A.,
Santizo Ruth O.,
Olmez Inan,
Spies Jeanie M.,
Buthmann Amanda,
Granowetter Linda,
Dulman Robin Y.,
Ayyanar Kanyalakshmi,
Gill Jonathan B.,
Carroll Aaron E.
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26711
Subject(s) - medicine , neutropenia , randomized controlled trial , chemotherapy , febrile neutropenia , pediatric cancer , intensive care medicine , cancer , pediatrics
Background The neutropenic diet (ND) is prescribed to avoid introduction of bacteria into a host's gastrointestinal tract and reduce infection. Due to a lack of evidence to support the ND, there continues to be debate among pediatric oncologists regarding its usefulness. This prospective randomized controlled trial evaluated the difference in neutropenic infection rates in pediatric oncology patients randomized to Food and Drug Administration approved food safety guidelines (FSGs) versus the ND plus FSGs during one cycle of chemotherapy. Procedure Pediatric patients receiving cancer treatment with myelosuppressive chemotherapy were eligible. Neutropenic infection was the primary outcome and defined as (i) fever with neutropenia or (ii) hospital admission and treatment for clinical infection and neutropenia. The rate of neutropenic infection was compared with Student's t ‐test for independent samples. Documented infections were identified by comprehensive chart review and compared between groups using a χ 2 test. Results : One hundred fifty patients were randomly assigned to FSGs (n = 73) or ND + FSGs (n = 77). The most common diagnoses were acute lymphoblastic leukemia (32%) and sarcoma (32%). There was no significant difference between the groups in the percentage of patients who developed neutropenic infection: FSGs 33% versus ND + FSGs 35% ( P = 0.78). Patients randomized to ND + FSGs reported that following the diet required more effort than those on FSGs alone. Conclusion The ND offers no benefit over FSGs in the prevention of infection in pediatric oncology patients undergoing myelosuppressive chemotherapy and adherence requires more effort for patients and families. Institutions caring for children with cancer should consider replacing ND guidelines with FSGs.