Necrotizing Enterocolitis and the Use of Thickened Liquids for Infants With Dysphagia

Abstract

Necrotizing enterocolotis (NEC) is a common cause of morbidity and mortality in infants that are born prematurely. The exact cause of NEC is not known. Clinical correlations between the use of thickened fluids and the development of NEC have been established. Thickened fluids are commonly used for the treatment of symptoms from both dysphagia and gastroesophageal reflux disease (GERD) in fragile infant populations. Despite its frequent recommendation, there is little empirical evidence to support the use of thickened fluids in pediatric populations for the treatment of dysphagia or GERD. There is emerging evidence to support the use of slower flowing bottle/nipple systems and side lying feeding position to support safe oral intake in infant populations. Speech-language pathologists who work in neonatal intensive care units and who work with other fragile infant populations must be aware of the risks associated with the use of thickened fluids in these populations and be prepared to provide alternative treatment options as appropriate.

The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology and Function: A Systematic Review

“…This dissertation is particularly noteworthy given the relative dearth of information regarding pediatric feeding and swallowing uncovered in our search process [ 17 – 19 ]. The Gosa study [ 72 ] reports several findings that concur with the observations gleaned from our qualitative synthesis, including prolongations of oral transit time and a reduction in penetration–aspiration with the nectar-thick stimulus compared to the thin liquid barium. Additionally, residue was reported to be present for 80 % of the nectar-thick swallows compared to only 44 % of thin liquid swallows.…”

“…As a post-script on this particular question, an additional source of data was brought to the attention of the authors after completion of the qualitative synthesis of the selected articles. This as-yet unpublished doctoral dissertation [ 72 ] involved rigorous videofluoroscopic exploration of swallowing with thin and nectar-thick Varibar™ barium by infants aged 3 weeks to 3 months, referred for evaluation of swallowing secondary to respiratory compromise. This dissertation is particularly noteworthy given the relative dearth of information regarding pediatric feeding and swallowing uncovered in our search process [ 17 – 19 ].…”

Effect of mixing method on resulting thickness of infant formula

“…Some thickening agents, such as rice cereal, have nutritional implications because they add macronutrients to the infant's formula (Garcia, Chambers, & Molander, 2005; Gosa et al, 2020). Additionally, there have been clinical reports of some thickening agents causing harm to an infant's developing gut (i.e., necrotizing enterocolitis) (Beal, Silverman, Bellant, Young, & Klontz, 2012; Gosa & Corkins, 2015). Thickening agents may also contain allergens.…”

A Systematic Process for Weaning Children With Aspiration From Thickened Fluids

“…It is critical that thickeners be used as a bridging strategy until swallowing skills improve or definitive management is carried out, rather than as an end-point treatment. Despite the widespread use of thickeners to prevent aspiration, there are a number of downsides to prolonged use related to financial cost, impaired quality of life, altered swallow physiology, altered nutritional composition, and even the risk of postswallow aspiration of pharyngeal residue . For these reasons, patients, caregivers, and clinicians are eager to discontinue or reduce thickener use whenever possible.…”

“…(pp1-20) Although this strategy may reduce the risk of aspiration and laryngeal penetration, use of thickeners should not be thought of as an end point. Using thickeners over a prolonged period can alter physiologic swallowing patterns, negatively affect quality of life, and pose a financial burden to families . Moreover, thickened fluids may increase the amount of postswallow residue in the pharynx and put the patient at risk for postswallow aspiration .…”