Evaluating the efficacy and impact of neutropenic diet in pediatric haematology patients: a longitudinal cohort study on adherence, clinical outcomes, and socioeconomic factors

Amitabh Singh ¹ Neetu Kushwaha ² Raja Sriswan ³ Shamssuz Zaman ⁴ Noreen Grace George ² Raj Kamal ² Sandeep Kumar Swain ² Manpreet Kaur ² Baseer Noor ² Prashant Prabhakar ¹ Bhavika Rishi ² Aroonima Misra ^2*

• ¹ Pediatrics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, National Capital Territory of Delhi, India
• ² ICMR- National Institute of child health and Development Research, New Delhi, India
• ³ National Institute of Nutrition, National Institute of Nutrition (ICMR), Hyderabad, Andhra Pradesh, India
• ⁴ National Institute of Cancer Prevention and Research (ICMR), Noida, Uttar Pradesh, India

Background & Aims: The neutropenic diet in pediatric haematology patients aims to reduce hospitalizations from febrile neutropenia and sepsis during chemotherapy. This study evaluated its effectiveness in improving mortality, morbidity, and overall outcomes, while considering limitations, adherence rates, and its impact on hospital admissions and culture positivity.Method: A prospective 18-month observational study was conducted on pediatric haematology patients in a tertiary care center's Pediatric Department. Using a baseline questionnaire at the introduction of a neutropenic diet, the study assessed clinical history, diagnosis, clinicopathological parameters, dietary recommendations, and socio-demographic data. Patients were followed for up to one year to evaluate diet adherence, outcomes, mortality, and morbidity, as indicated by hospital admissions for febrile neutropenia.Results:An analysis involving 100 patients was conducted to assess adherence to the neutropenic diet and its ramifications on clinical outcomes over a period of 18 months. Initial follow-up data were accessible for 83 patients, revealing an adherence rate of 66%, which subsequently declined to 57% following a six-month interval.. Patients were categorized as compliant or non-compliant, but no correlation was found between adherence and febrile admissions, sepsis, hospitalizations, or mortality. Among compliant patients, 62% showed sepsis signs, though only 19% had positive blood cultures in whole study group. Nonadherence was linked to demographic factors such as large family size, financial constraints, and limited resources. The neutropenic diet showed minimal impact on morbidity and mortality.