Abbey Sterkowitz

Thickening Infant Liquids without the use of External Commercial Thickeners

Group members: Anna Maunu and Abigail Spoden

Advancements in neonatal medicine have resulted in an increased prevalence of medically complex infants who frequently suffer from swallowing deficits (dysphagia). These deficits can cause milk to enter into the infant’s lungs when they feed and lead to infant morbidity and mortality. While thickened liquids are a commonly used intervention to mitigate these swallowing deficits, immaturity of the infant gut prevents the utilization of many commercially available thickeners. The objective of the current investigation was to test the ability of filling this void in dysphagia treatments by increasing milk thickness without the addition of harmful thickeners using the International Dysphagia Diet Standardization Initiative (IDDSI) standards. We did this by testing the effect of anti-reflux formulas, their ready-to-feed formula correlates, caloric density, and time on infant formula thickness. Powder and ready-to-feed infant formulas (Enfamil Infant, Enfamil A.R., Similac Spit-Up, Similac Advance) were gravity flow tested using IDDSI methodology at caloric densities ranging from 20-30kcal/oz. Enfamil A.R. was the only formula to classify as thickened across all testing conditions. It remained slightly thick over time in its ready-to-feed 20kcal/oz form, however it increased from thin to slightly thick in the powder form. Increasing caloric density increased its viscosity to moderately thick levels at 28kcal/oz. The results demonstrate the potential for Enfamil A.R. to be utilized as a thickener for dysphagia management. Future investigations examining nutritional and gastric safety of this methodology are warranted prior to clinical application.

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