... Prevalence and Management of Constipation in Pediatric Patients Undergoing Chemotherapy: A Retrospective Review *Megan Parod, OMSIII1,*Trisha Reddy, MD2, Jennifer A. Belsky DO, MS1,2,3 1Marian University College of Osteopathic Medicine 2Department of Pediatrics, Indiana University School of Medicine 3Division of Oncology, Riley Hospital for Children Background Children with acute lymphoblastic leukemia (ALL) suffer a litany of therapy induced side effects Methotrexate is a common chemotherapy agent administered for the treatment of ALL Failure to clear methotrexate from the body can result in toxicities including mouth sores, mucositis, and organ dysfunction, which have been well documented in the literature To date, no studies have examined the correlative relationship between delayed methotrexate clearance and constipation This study aims to examine chemotherapy induced constipation, current management practices, and the relationship between delayed clearance of methotrexate and constipation Methods Single institution, retrospective cohort study, analyzed data from Riley Hospital for Children Patients birth to 21 years of age with ALL, hospitalized for high dose intravenous methotrexate therapy from January 2010 to September 2021 Constipation definition: no stool for greater than 48 hours documented in the inpatient EMR Cerner system Demographics and Clinical Characteristics Entire Cohort N (%) 23 6.7 (0 - 26) Characteristic Unique Patients Median age (years) at Induction (range) Sex Female Male Race White Black Asian American Indian Pacific Islander Other/Unknown Ethnicity Hispanic or Latino Non-Hispanic or Latino Management of Constipation 5 (26) 17 (74) 20 (87) 1 (4.3) 2 (8.6) 0 (0) 0 (0) 0 (0) 2 (8.7) 21 (91.3) Table 1: Demographics and clinical characteristics of pediatric patients with ALL (Pediatric Hospital Information System, 2010-2021) Admission Information Characteristic Unique Admissions Average Length of Stay Range of Length of Stay Historical Constipation During Previous Admissions N (%) 61 5 days 3-29 days 31 (50.8) Did Not Have Last Stool Documented Prior to Admission 53 (91.4) Concomitant Chemotherapy Medications Given 57 (96.6) Vincristine Given with High Dose Methotrexate 56 (91.8) Mercaptopurine Given with High Dose Methotrexate 57 (93.4) Concomitant Opioids Prescribed During Admission 13 (22.7) Constipation During Admission 17 (27.9) Table 3: Evaluating methotrexate clearance and management of constipation in patients during admission Discussion and Next Steps We identified that 27.9% of patients with ALL who received methotrexate therapy during hospitalization suffered from constipation, with 88.2% of these patients experiencing delayed methotrexate clearance Half of admitted, constipated patients were prescribed constipation medications PRN that were then given 5.9% of the time In addition to their prolonged hospitalizations, majority of patients received vincristine, contributing to constipation Future prospective studies should focus on standardizing bowel regimens and increased attention must be paid to patients receiving constipating chemotherapy agents References and Complete Poster Available Table 2: Exploring admission data of patients receiving high dose methotrexate INDIANA UNIVERSITY SCHOOL OF MEDICINE Marian University College of Osteopathic Medicine References 1. 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