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Feed thickeners and NEC: too risky to chance

Journal of Perinatology volume 32, page 479 (2012)Cite this article

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We thank Dr Woods et al.1 for reporting three ex-preterm infants who developed late-onset necrotizing enterocolitis (NEC) within a short period of being commenced on a xanthan gum-derived feed thickener. We note that as of May 2011 when the FDA warned against the use of SimplyThick in infants who had been born prematurely, 15 cases of NEC (including two deaths) had occurred in preterm infants who had been fed SimplyThick with their milk.2

Almost 8 years ago, we reported two preterm infants who died of fulminant NEC shortly after being commenced on a commercially available carob bean (locust bean) gum-thickening agent for suspected gastro-esophageal reflux (GER).3 In their recent systematic review of thickened feed interventions for GER in infants, Horvath et al.4 discussed the safety aspects of thickeners but may have overlooked our earlier report, because a possible association with NEC was not mentioned as a safety concern. Similarly, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Gastroenterology, Hepatology, and Nutrition joint clinical practice guideline for pediatric GER discusses treatment of GER using feed thickeners, but without any specific caution for their use in preterm infants.5 Irrespective of only modest possible benefits from feed thickening in treatment of GER,4, 5 we have found it perturbing that feed thickeners continue to be recommended for treatment of GER in preterm-born infants,6 despite the absence of safety data.

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References

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Authors and Affiliations

  1. Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

    P Clarke

  2. Honorary Consultant Paediatrician, Salford Royal NHS Foundation Trust, Salford, UK

    M J Robinson

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  1. P Clarke
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  2. M J Robinson
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Correspondence to P Clarke.

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The authors declared no conflict of interest.

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Clarke, P., Robinson, M. Feed thickeners and NEC: too risky to chance. J Perinatol 32, 479 (2012). https://doi.org/10.1038/jp.2012.23

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