After a hematopoietic stem cell transplant, children have low immunity and are very susceptible to infections. Children with delayed implantation or graft rejection, and children with post-transplant adverse reactions such as skin and gastrointestinal reactions known as graft versus host disease (GVHD), are more likely to develop infections. Although protective environment and prophylactic application of antibiotics can reduce the rate of infection in children after bone marrow transplantation to some extent, some children still develop serious infections after transplantation and even die as a result. Therefore, it is important for parents to learn how to properly care for them. Here are some tips to help parents take better care of their children:
Provide an isolated environment for your child
High-efficiency air filtration devices are used in laminar flow rooms to improve the cleanliness of the air, which can prevent exogenous infections. Doctors generally determine the length of time a child stays in the laminar flow room based on the cleanliness of the environment and the speed of recovery of the child’s blood picture. Parents should pay attention to the granulocyte proliferation in their child’s blood draw results and inform the physician in a timely manner so that the physician can decide when the child should leave the laminar flow room.
Helping your child take antibiotics
Antibiotics are primarily for endogenous infections. Parents should follow the doctor’s orders and help their child take oral antibiotics in regular doses. If the child has graft-versus-host disease, the doctor may use an intravenous infusion of broad-spectrum antibiotics to prevent infection.
Cooperate with the doctor to apply blood products to your child
Immunoglobulin shots contain G-CSF (granulocyte colony-stimulating factor) and GM-CSF (granulocyte-macrophage colony-stimulating factor), which promote hematopoietic recovery. For 100 days after the transplant, the doctor will give the child weekly immunoglobulin drips to prevent viral infections. Parents need to cooperate with the doctor by closely monitoring their child’s condition during the IV and notifying the healthcare provider of any problems.
Aseptic care
As a parent, you need to take aseptic care measures to help prevent infection in your child. Parents need to provide a low germ diet (no raw fruits and vegetables outside, no take-out, no raw food, etc.) until at least 100 days after transplantation, and they need to provide clean living conditions, clothing, and related utensils to avoid infection outside.
Parents also need to teach their child good personal hygiene, such as proper hand washing, daily bathing, and good oral hygiene habits.
Watch for signs of infection
After the transplant is out of the hamper, parents need to learn to recognize the symptoms of early manifestations of infection to help get it under control and treated in a timely manner. Children should seek medical attention if they show the following symptoms:
- The child has broken and ulcerated skin with edema and erythema;
- The child has a cough, rapid breathing, a runny nose, the child feels a sore ear and a sore throat
- The child develops inflammation of the mouth, red and swollen gums, ulcers on the cheek mucosa, and difficulty swallowing things
- Child feels pain around the anus, or develops diarrhea, etc.
- The child feels pain around the anus, or has diarrhea.
Follow up with the doctor on time
The doctor will follow up with the child at least once a week for 100 days after the transplant to do basic tests and to adjust the dose of medication. It is important for parents to receive timely information from the doctor about follow-up visits and to keep up with them.
After 100 days of transplantation, parents can receive follow-up visits every 2 weeks or every month, depending on their child’s condition, or even at longer intervals. The doctor will assess the child’s primary disease, organ function, and immune function at the follow-up visit, and the doctor will assess the endocrine function in children over 8 years of age, so parents should be aware of their child’s condition and the doctor’s recommendations.
The routine follow-up time points of 6 months, 12 months, 24 months, and 36 months after the child’s transplant are important for parents to keep in mind and receive timely follow-up information from the doctor.
Timely vaccination
In the first and second years after transplantation, as immune function is gradually re-established, parents should be aware of the need to re-vaccinate their child against infectious diseases.
- For dead vaccines and toxins (e.g., Streptococcus pneumoniae vaccine, Haemophilus influenzae type B vaccine), parents should allow their child to use them 1 year after transplantation and in the absence of chronic graft-versus-host disease.
- For live attenuated vaccines (e.g., MMR), use them 2 years after the child’s transplant and without chronic graft-versus-host disease; for those with chronic graft-versus-host disease, do not give them until 18 months off immunosuppression.