Necrotizing enterocolitis in low-birth-weight infants fed an elemental formula

Book, Linda S.; Herbst, John J.; Atherton, Stephen O.; Jung, August L.

doi:10.1016/s0022-3476(75)80835-3

Cited by 166 publications

(63 citation statements)

References 12 publications

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“…Sántulli et al [8] reported NEC in term infants who were fed with hyperosmolar (750 mOsm/kg) milk feeds. Book et al [9] noted NEC in 7 of 8 infants weighing <1,200 g, when fed on elemental formula with an osmolality of 650 mOsm/kg. Willis et al [10] reported an increase in NEC with the administration of hyperosmolar calcium supplements (>1,700 mOsm/kg) and observed a statistically significant reduction following dilution of the calcium supplements with water to an osmolality of 405 mOsm/kg.…”

Section: Introductionmentioning

confidence: 99%

“…Hyperosmolality has a consequential effect on the enteral nutrition of newborn infants, especially VLBW infants, because of its close relationship to feed intolerance and NEC. While the pathogenesis of NEC is multifactorial, hyperosmolar feeds have been shown to be a causative factor, with prematurity being the major risk factor [9,10,14,15]. The osmolality of milk in the stomach and duodenum was determined by Billeaud et al [16], who noted raised osmolality at 45 and 180 min following formula milk feeds, leading to prolonged exposure of the gut wall to hyperosmolar solutions.…”

Section: Introductionmentioning

confidence: 99%

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Medications That Increase Osmolality and Compromise the Safety of Enteral Feeding in Preterm Infants

Chandran

Chua²,

Lin³

et al. 2016

Neonatology

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Background: Medications added to preterm milk feeds have the potential to raise osmolality, causing feed intolerance and necrotizing enterocolitis. Objective: The aim of this study was to evaluate changes in the osmolality of milk feeds and water with 14 medications and the diluent amounts required to keep the osmolality below the safety threshold of ≤450 mOsm/kg. Changes in the osmolality of milk with medications while on continuous infusion over 2 and 4 h were determined. Methods: This study was designed to measure the osmolality of 14 commonly used medications in preterm infants both neat and when supplemented with expressed breast milk (EBM), EBM with fortifier (EBMF), preterm formula (PTF), and water. Dose-effect curves were plotted, and the volume of each diluent was calculated to keep the osmolality ≤450 mOsm/kg. Time-effect curves were plotted at 2 and 4 h for each medication for both EBM and EBMF. Results: Neat osmolality of all except 5 medications were above 2,000 mOsm/kg. The osmolality rose with decreasing proportions of diluents used, depicting an indirect curvilinear relationship between the increasing dilution and osmolality for all except 2 medications. As a diluent, EBM was required in lower dilutions than EBMF. Dilutions needed for additives with PTF were very similar to those of EBM. The change in osmolality over time with additives was statistically significant for EBMF. Conclusions: EBM and PTF were found to be safer diluents than EBMF for enteral additives. The practice of keeping milk feeds with medications for continuous feeding is safe for a period of 4 h in EBM.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medications That Increase Osmolality and Compromise the Safety of Enteral Feeding in Preterm Infants

Chandran

Chua²,

Lin³

et al. 2016

Neonatology

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“…However, there have been numerous reports of feeding intolerance or necrotizing enterocolitis associated with hyperosmolar feedings. [3][4][5][6][7][8] In 1978, Pascale et al 9 showed that a high osmolar load delayed gastric emptying in low birth weight infants. In our study, the addition of vitamin drops, alone, sent all milks tested well over the AAP recommended osmolality limit of Infants that have experienced severe gastrointestinal complications (one or more episodes of necrotizing enterocolitis, short bowel syndrome, severe gastroesophageal reflux, and so on).…”

Section: Discussionmentioning

confidence: 99%

Milk as a vehicle for oral medications: hidden osmoles

et al. 2011

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Objective: Once critically ill, preterm infants have transitioned to enteral or oral feedings, it is common to mix oral medications with milk feedings. The osmolality of oral and intravenous drugs were tested in the 1980s and many were found to exceed the American Academy of Pediatrics (AAP) recommended limit (400 mOsm kg À1 H 2 O). Many new milks and medications have entered the neonatal intensive care unit (NICU) since then. The objective of this study was to measure the osmolality of common milk-medication combinations administered in the NICU.Study Design: Common milk-medication mixtures were analyzed for osmolality by freezing point depression.Result: Only Elecare (30 kcal per oz) exceeded AAP recommendations for osmolality in its unadulterated state. The addition of multivitamins alone resulted in an osmolality that exceeded 400 mOsm kg À1 H 2 O. The cumulative addition of other medications resulted in some osmolalities >1000 mOsm kg À1 H 2 O. Conclusion:The coadministration of medications with milk products should be evaluated as a potential contributor to gastrointestinal intolerance of feedings in preterm infants.

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“…135,136 However, one small study suggested that the use of elemental diets may be associated with an increased incidence of necrotizing enterocolitis. 137 …”

Section: Pediatricsmentioning

confidence: 99%

Nutritional support

Ofman

Koretz

1997

Aliment Pharmacol Ther

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Nutritional support currently accounts for about 1% of the total health care costs in the USA. Interestingly, most of the prospective randomized controlled trials to date have not been able to demonstrate that this therapeutic intervention alters morbidity or mortality. In fact, parenteral nutritional support may predispose the recipients to developing systemic infections. There have been a few areas in which nutritional support may be of benefit. Enteral supplements given to underweight women who suffer hip fractures reduce the hospital stay and, presumably, overall cost. Preoper‐ative parenteral nutritional support may produce a small absolute reduction in post‐operative morbidity, but its cost becomes prohibitive. Preoperative enteral nutritional support, especially if carried out in the home, may be of benefit (using the most optimistic interpretation of a small number of trials); if so, it is an economically defensible intervention. Particular nutrients or diets may have specific effects on certain disease processes. Indirect comparisons have suggested that elemental diets can be used to treat flares of Crohn's disease (perhaps because putative food antigens are removed). However, corticosteroid therapy is more efficacious. Furthermore, it is less expensive to employ 6‐mercaptopurine as the next modality in steroid failures. Branched‐chain amino acid infusions may have some effect on hepatic encephalopathy, but again, lactulose is less expensive. Nutritional support is one area of medicine in which there has been far more enthusiasm than the data justify. Disease‐associated malnutrition probably is a secondary phenomenon, not an important cause of morbidity. The widespread use of this modality cannot be justified in a cost‐constrained health care system.

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Necrotizing enterocolitis in low-birth-weight infants fed an elemental formula

Cited by 166 publications

References 12 publications

Medications That Increase Osmolality and Compromise the Safety of Enteral Feeding in Preterm Infants

Medications That Increase Osmolality and Compromise the Safety of Enteral Feeding in Preterm Infants

Milk as a vehicle for oral medications: hidden osmoles

Nutritional support

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