Consensus Recommendations for Nutritional Intervention in Pediatric Oncology (Ages 4–18 Years) on Behalf of the Romanian Society of Pediatric Hematology and Oncology and the Romanian Society of Pediatric Gastroenterology, Hepatology and Nutrition

Background: Malnutrition, encompassing both undernutrition and overnutrition, is a common complication in children with cancer and is associated with impaired treatment tolerance, increased infection risk, altered pharmacokinetics, reduced quality of life, and poorer survival outcomes. Despite its importance, nutritional management in pediatric oncology lacks a unified, systematically organized clinical framework applicable to the full trajectory of the disease. Objective: This study aimed to develop expert consensus recommendations for nutritional intervention in pediatric oncology patients aged 4 to 18 years. Methods: A modified electronic Delphi (e-Delphi) process was conducted with a multidisciplinary expert panel of 22 specialists, including pediatric oncologists, pediatric gastroenterologists, clinical nutrition specialists, radiotherapy specialists, and pediatric surgeons. Statements were rated on a 9-point Likert scale across two anonymous rounds, with consensus predefined as ≥80% agreement. Results: Forty-one consensus recommendations were formulated across nine domains: nutritional screening and assessment, energy and protein requirements, micronutrient supplementation, physical activity, nutritional support escalation, refeeding syndrome prevention, treatment-specific management, survivorship, and palliative care. All recommendations achieved the predefined consensus threshold. Conclusions: This Delphi consensus provides a structured, multidisciplinary, and clinically actionable framework for nutritional management across the full trajectory of childhood cancer and is intended to reduce institutional variability and improve patient outcomes.