Last year the FDA issued a warning regarding food thickeners and necrotizing enterocolitis (FDA: Do not feed SimplyThick to premature infants). More details are now available (J Pediatr 2012; 161: 354-6).
This information was derived from a series of cases of NEC with a common antecedent, the use of SimplyThick. After excluding infants with multiple episodes of NEC prior to use of this thickening agent, 22 infants met the case definition and were included in the report.
16 infants started SimplyThick >37 weeks post-menstrual age (PMA). 19 infants developed NEC >37 weeks PMA. 14 cases required surgery and 7 patients died. The number of days of SimplyThick exposure:
- 9 patients –1-10 days
- 7 patients –11-20 days
- 6 patients –>20 days
- Median –13 days
Since most cases of NEC occur in the hospital and are associated with extreme prematurity, these cases are unusual & likely causally related to the use of SimplyThick. Delayed NEC can also occur with congenital heart disease. Also, NEC often develops shortly after the introduction of enteral feedings; in this series, patients had been receiving enteral feeds for a median of 43 days prior to NEC onset. As a consequence, 50% of patients were at home when NEC developed.
The authors postulated that an increased production of short-chain fatty acids by breakdown of xanthan gum component was the mechanism for SimplyThick to increase the risk of NEC.
In a brief commentary on the article, Alan Jobe states that “Neonatologists seem determined to treat the poorly defined reflux that frequently occurs in preterm infants with something –preferably drugs that are off-label and have no proven efficacy…Perhaps clinicians should restrain their enthusiasm for other thickeners for the feeding of preterm infants as well. The proven treatments for reflux in otherwise normal preterm infants are time and patience.”
While Dr. Jobe makes some helpful points, SimplyThick has been used primarily for swallow dysfunction rather than reflux. Nevertheless, any thickeners as well as reflux medications can increase the risk of NEC and should be used cautiously.
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