Premium
Current methods of thickening feeds for preterm infants with gastroesophageal reflux disease is highly variable
Author(s) -
Koo Jenny K,
Bode Lars,
Kim Jae H
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.151.5
Subject(s) - gerd , reflux , thickening , medicine , food science , viscometer , xanthan gum , gastroenterology , viscosity , chemistry , disease , rheology , materials science , polymer science , composite material
Background Gastroesophageal reflux disease (GERD) is a common problem in neonates, especially in preterm infants. The mainstay therapy for GERD begins with repositioning, adjustment of feeding rate, followed by thickening of feeds, then with pharmacologic intervention, and finally surgery. A large meta‐analysis of randomized controlled trials demonstrated effective reduction of GERD symptoms in infants fed thickened feeds. Infants who received thickened feeds also demonstrated better weight gain. Objective To measure the viscosity effect of different thickening strategies for preterm infants with GERD Methods We thickened donor human milk (DHM) and formula using various thickeners: starch based thickeners (SBT) (Thick It™), xanthan gum based thickeners (GBT) (Simply Thick™, Thicken Up Clear™), carob GBT (GelMix™) or rice cereal. We also assessed formula with added starches that are marketed for reflux, including Simlac Spit Up™ and Enfamil AR™. The viscosity of each sample was measured at 0, 15, 30 and 60 minutes after the addition of thickeners. Each sample of milk or formula was thickened per manufacturer recommendations for each of the products, with a goal of achieving nectar‐thick consistency. The acidity (pH) of each sample was measured and in separate trials, 3M HCl and 0.1M HCl was added to the milk and thickener mixtures to mimic the range of acidity in the stomach. Two temperatures, room temperature and 37°C, were evaluated, DHM was tested with and without human milk fortifiers (HMF). Acidity was also controlled to mimic the range of gastric pH. Viscosity of the milk was measured using a rotary viscometer (NDJ‐1, NDJ, China) that had the ability to measure viscosity between 10 to 100,000 mPa*s +/− 5% error. Results Formula can be effectively thickened with all types of thickeners, and the viscosities of thickened formula quickly achieve a nectar‐thick consistency and subsequently continue to thicken over time. On the other hand, DHM does not effectively thicken with SBT. DHM went back to baseline viscosity (thin liquid) within 15 minutes of adding SBT. Both DHM and formula, when thickened with rice cereal, formed a non‐homogenous mixture that rendered viscosity readings imprecise given the vast range of viscosities within the same fluid sample. Acid ablated the effects of xanthan GBT while carob GBT retained some thickening potential. An acid pH effectively thickened anti‐regurgitation formulas. Conclusions Current thickening strategies of preterm infant feeding produces highly variable results in final feed viscosity. Objective measures of liquid viscosity are recommended for adequate comparisons of thickening efficacy and changes to thickening regimen. Careful consideration of acidity and time need to be observed. Human milk continues to be the most challenging feed type to thicken in a controlled manner. Support or Funding Information This research was supported by divisional funds.