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Thickened Feedings for Premature Infants in the NICU

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Presentation on theme: "Thickened Feedings for Premature Infants in the NICU"— Presentation transcript:

1 Thickened Feedings for Premature Infants in the NICU
Erin Pryor, MPH, RD, LD April 12, 2012 ONN Spring Meeting Columbus, Ohio

2 History of Thickening Feeds1
Thickening of infant formulas for treatment of GER for > 50 years - cereal, rice, bean gum, pectin, cellulose Rationale: Thickening increases the stickiness and weight of the feeds - Controversial with evidence of delayed gastric emptying Alternative treatment modalities Prone position with head at 30 degrees Smaller frequent feedings Histamine H-2 antagonists/Proton pump inhibitors Time Severe cases: surgery 1. Reviewers: Huang R-C, Forbes DA, Davies MW

3 Thickening Feeds Common practice yet no evidence of effectiveness
- Lack of randomized, controlled studies of non- pharmacological management of GER Spontaneous resolution occurs more frequently in premature neonates Theoretical disadvantages Delayed gastric emptying Increased caloric density Constipation

4 Diagnostic Tests2 pH probe test Barium swallow study Upper GI
Radionuclide milk scans to detect pulmonary aspiration 2. Feed thickener for newborn infants with gastro-oesophageal reflux (Review) The Cochrane Collaboration. Published by John Wiley & Sons, Ltd

5 Simply Thick® Xanthan gum-based thickener used in the management of dysphagia Water holding capacity of a non-starch polysaccharide that acts as a soluble food fiber3 Speculation from case review: - Stimulation of an immature gut by xanthan gum4 Sharp K, Ward L, Cichero J, Sopade P, Halley P. Thickened fluids and water absorption in rats and humans. Dysphagia 2007; 22: Woods, CW, Oliver T, Lewis K, Yang Q. Development of necrotizing entercolitis in premature infants receiving thickened feeds using Simply Thick®

6 Case Study Male Premature Infant: 30+6 wks, 1500 gms @ birth
DOL 1: TPN DOL 2: Feeds started of 20 kcal/oz EBM/SC per feeding protocol DOL 6: Increased to 24kcal/oz EBM/SC DOL 7: Vits added DOL 10: Full feeds ~150cc/kg DOL 15: Out of EBM DOL 46: Neosure 22kcal/oz, tolerating formula well DOL 52: Noted “Mom feeding well, plan for DC tomorrow”

7 Case Study DOL 52 Evening: Event needing mod stim w/feeds, dusky in color DOL 55: Event needing vigorous stim x 2 w/ feeds DOL 56: Event needing vigorous stim x 1 w/ feeds DOL 57: 39+2 wks Swallow Study w/ UGI (See OT note) Wt. 3190, cc/day Initial Recipe: 80 ml Neosure 22kcal 10 ml sterile water ~27 kcal/oz 4.5 tsp Rice cereal MD documented much improved with thickened feeds DOL 60: RN reported difficulty w/ Dr. Browns nipple, taking less volumes and >25 minutes to feed

8 Case Study DOL 60: Tried yellow nipple with some reported improvement
DOL 61: Yellow nipple clogging. Tried Avent Bottle 1 & 2 Flow New Recipe: 80 ml Neosure 22kcal 10 ml sterile water ~26kcal/oz 3.75 tsp rice cereal DOL 62: New Recipe 10 ml sterile water ~25kcal/oz 3 tsp Rice cereal DOL 67: 40+5 wks Only 1 documented event with sleeping (self stim) in the last 5 days since thickened feeds. Infant discharged. Formula mixing done with mom. Follow up with high risk nutrition clinic and GI.

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