The Effect of Additives for Reflux or Dysphagia Management on Osmolality in Ready‐to‐Feed Preterm Formula: Practice Implications

Levy, Deborah Salle; Osborn, Erika; Hasenstab, Kathryn A.; Nawaz, Selina; Jadcherla, Sudarshan R.

doi:10.1002/jpen.1418

Cited by 19 publications

(7 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, the processes involving infant diet, volume intake, milk type, position during feeding, caloric density, osmolality of feedings, use of feeding pumps and gavage tube, or transitional and/or oral feeding methods can influence GER. [12,19]…”

Section: ) Perceptions Of Parents and Providersmentioning

confidence: 99%

Gastroesophageal Reflux Disease in the Neonatal Intensive Care Unit Infant

Gulati

Jadcherla

2019

Pediatric Clinics of North America

Self Cite

View full text Add to dashboard Cite

In this review, we discuss gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) as it pertains to the infant in the NICU based on research in this specific population. Specifically, we summarize the developmental biology of the gastroesophageal junction (GEJ), the physiology of GER and the pathophysiology of GERD in the NICU infant setting, and identify risk factors for GER and GERD. We also address the epidemiology, economic burden and controversies surrounding GERD in the NICU infant, and formulate an approach to GER and GERD in his patient population. Finally, we examine the recent advancements in the individual assessment of GER and GERD in the NICU infant, and provide evidence-based guidelines that can be adopted.

show abstract

Section: ) Perceptions Of Parents and Providersmentioning

confidence: 99%

Gastroesophageal Reflux Disease in the Neonatal Intensive Care Unit Infant

Gulati

Jadcherla

2019

Pediatric Clinics of North America

Self Cite

View full text Add to dashboard Cite

show abstract

“…Despite the theoretical simplicity of adding a thickening agent to a liquid to prevent airway compromise during the swallow, the successful clinical implementation of this compensatory strategy has proved challenging. Research has shown that factors such as time elapsed from mixing liquid to time of consumption, temperature of the liquid at the time of consumption, nutritional make‐up of the liquid, and type of thickening agent used to thicken the liquid can all significantly alter the resulting thickness of the liquid (Frazier et al, 2016; Garcia, Chambers, & Molander, 2005; Gosa & Dodrill, 2017; Levy, Osborn, Hasenstab, Nawaz, & Jadcherla, 2019; O'Leary, Hanson, & Smith, 2010; Payne, Methven, Fairfield, & Bell, 2011; Yoon & Yoo, 2017). Variation in resulting liquid thickness can have detrimental effects on the person with dysphagia.…”

Section: Introductionmentioning

confidence: 99%

“…The type of thickening agent used in dysphagia management affects the thickness of the resulting therapeutic infant formula consistency differently by altering the osmolality of the formula as well as the nutritional makeup of the formula (Duncan, Larson, & Rosen, 2019; Levy et al, 2019). Various studies have shown significant differences in the resulting thickness of liquids between commercially prepackaged prethickened (CPPT) beverages and instant food thickened (IFT) beverages (Adeleye & Rachal, 2007; Dewar & Joyce, 2006; Garcia, Chambers, Matta, & Clark, 2008).…”

Section: Introductionmentioning

confidence: 99%

Effect of mixing method on resulting thickness of infant formula

Rush

Bolland

Gosa

2020

Journal of Texture Studies

View full text Add to dashboard Cite

Previous research shows that factors such as time, temperature, nutritional make‐up of a liquid, and type of thickening agent can significantly alter the resulting thickness of liquids. This study sought to determine the effect of three distinct mixing methods on the resulting thickness of ready to feed infant formulas mixed to Mildly and Moderately Thick (International Dysphagia Diet Standardization Initiative [IDDSI] Levels 2 and 3) with three different thickening agents. Eight commercially available infant formulas were mixed with three different thickening agents by three different mixing methods. The IDDSI Syringe Flow Test was used to categorize the thickened formulas. Chi square analyses were completed to determine the impact of mixing method on the thickened formulas. The majority (94%) of thickened formula combinations prepared to a target Mildly Thick consistency produced thickened formula that was thinner or thicker than the target. In contrast, the majority (76%) of thickened formula combinations prepared to a target Moderately Thick (IDDSI Level 3) consistency produced thickened formula that was equivalent to the target consistency. A statistically significant relationship was found between mixing methods and resulting IDDSI category for samples mixed to a target of Moderately Thick. The thickening agent and method of mixing must be considered carefully when preparing infant formulas to Mildly and Moderately Thick target IDDSI categories. Based on results of this study, it is recommended that providers utilize a clinical testing method, such as the IDDSI Syringe Flow Test, when attempting to create a Mildly Thick formula consistency.

show abstract

“…However, gastrointestinal effects have been reported from use of thickening agents in infants with diarrhoea in up to 27% [28,34,35]. Thickening increases fluid osmolarity above the threshold recommended by the American Academy of Pediatrics [36 ▪▪ ]. This can impact on gastro-intestinal transit and absorption resulting in pain, regurgitation and chronic mucosal changes in the gut requiring further investigation and intervention [36 ▪▪ ].…”

Section: Dangers Of Thickened Fluidsmentioning

confidence: 99%

Thickened liquids: do they still have a place in the paediatric dysphagia toolkit?

Stewart

Burr

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

View full text Add to dashboard Cite

Purpose of review Use of thickened fluids has long been a cornerstone of dysphagia management. However, clinicians and researchers are increasingly questioning their effectiveness and highlighting potential harms. This review aims to present the current state of the evidence for use of thickened fluids in children. Recent findings The relationship between aspiration and respiratory infection is complex. The role of thickened fluids in improving respiratory health is limited and contradictory. A high level of variability exists in all aspects of thickened fluid use. Little is known about patient and family perspectives on meaningful endpoints for intervention. Summary Clinicians should be open and transparent in their decision making with patients and families, acknowledging the limited evidence and the need for individualised care. Further research is needed to establish the efficacy of thickened fluid use in children with regard to improvements in respiratory health, fluid intake and child and family wellbeing.

show abstract

The Effect of Additives for Reflux or Dysphagia Management on Osmolality in Ready‐to‐Feed Preterm Formula: Practice Implications

Cited by 19 publications

References 48 publications

Gastroesophageal Reflux Disease in the Neonatal Intensive Care Unit Infant

Gastroesophageal Reflux Disease in the Neonatal Intensive Care Unit Infant

Effect of mixing method on resulting thickness of infant formula

Thickened liquids: do they still have a place in the paediatric dysphagia toolkit?

Contact Info

Product

Resources

About