Impact of Nursing-Led Immunonutrition Programs on Immune Reconstitution and Infection Reduction in Pediatric Hematopoietic Stem Cell Transplant Recipients

Introduction and Objective: Pediatric hematopoietic stem cell transplantation (HSCT) serves as a curative treatment for a wide range of malignant and non malignant disorders but is frequently associated with prolonged immune suppression and increased susceptibility to infections. Emerging evidence highlights the pivotal role of targeted nutritional interventions particularly immunonutrition in enhancing post transplant immune recovery. Nursing led immunonutrition programs, through continuous engagement with patients, enable personalized delivery, monitoring, and adjustment of immune enhancing nutrients. This systematic review aimed to synthesize the most recent evidence on the effects of these nursing driven interventions on immune reconstitution parameters and infection reduction among pediatric HSCT recipients. Methods: Following PRISMA ۲۰۲۰ guidelines, seven electronic databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, and ProQuest) were searched for studies published from January ۲۰۲۰ to August ۲۰۲۵. Eligible articles included randomized controlled trials, cohort studies, and quasi-experimental research evaluating nursing-led immunonutrition (e.g., glutamine, arginine, omega- ۳ fatty acids, nucleotides) in pediatric HSCT recipients, with reported outcomes on immune cell recovery, cytokine modulation, and infection incidence. Only English-language, peer-reviewed studies were included. Results: Fifteen studies (n=۱,۳۲۶ children) from Asia, Europe, and North America met inclusion. criteria. Nursing-led protocols varied from early enteral immunonutrition initiation (within ۴۸ hours post- HSCT) to combined educational and monitoring interventions extending six months post-discharge. Common formulations enriched with arginine, omega-۳ fatty acids, and glutamine demonstrated accelerated lymphocyte recovery (mean CD۴+ restoration at day ۶۰ vs. day ۹۰ in standard care), lower pro- inflammatory cytokine peaks (IL-۶ reduction up to ۳۴%), and improved NK-cell activity. Infection rates declined markedly bloodstream infections by ۲۲-۳۸% and severe viral reactivations by up to ۲۹% with several trials noting shorter hospitalization by ۴-۶ days. Studies also reported improved mucosal integrity, reduced mucositis severity, and higher patient-reported quality-of-life scores. Adherence exceeded ۸۵% where nurses implemented direct bedside counseling and follow-up reinforcement, highlighting nursing's pivotal role in sustainability and compliance. Conclusion: Nursing-led immunonutrition programs significantly enhance post-HSCT immune recovery and reduce infectious complications in pediatric patients. Integration of standardized, evidence-based protocols into routine transplant care could optimize clinical outcomes and shorten recovery trajectories. Further multicenter studies are warranted to refine nutrient compositions, intervention timing, and nursing education strategies for maximal benefit.

کلیدواژه ها:

Pediatric Nursing ، Immunonutrition ، Hematopoietic Stem Cell Transplantation ، Immune Reconstitution ، Infection Prevention ، Nutritional Support ، Clinical Outcomes