1 / 8

Thickened Feedings for Premature Infants in the NICU

Thickened Feedings for Premature Infants in the NICU. Erin Pryor, MPH, RD, LD April 12, 2012 ONN Spring Meeting Columbus, Ohio. History of Thickening Feeds 1. Thickening of infant formulas for treatment of GER for > 50 years - cereal, rice, bean gum, pectin, cellulose

tad
Download Presentation

Thickened Feedings for Premature Infants in the NICU

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Thickened Feedings for Premature Infants in the NICU Erin Pryor, MPH, RD, LDApril 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 http://www.nichd.nih.gov/chochrane/Huang/Huang.htm

  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. 2009.

  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: 193-203. • 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 wksSwallow Study w/ UGI (See OT note) Wt. 3190, 550-680cc/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 80 ml Neosure 22kcal 10 ml sterile water ~25kcal/oz 3 tsp Rice cereal • DOL 67: 40+5 wksOnly 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.

More Related