Frazier Jacqueline, Chestnut Amanda H, Jackson Arwen, Barbon Carly E A, Steele Catriona M, Pickler Laura
Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, Box 030, Aurora, CO, 80045, USA.
Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, M5G 2A2, Canada.
Dysphagia. 2016 Oct;31(5):672-9. doi: 10.1007/s00455-016-9726-6. Epub 2016 Jul 13.
When assessing swallowing in infants, it is critical to have confidence that the liquids presented during the swallow study closely replicate the viscosity of liquids in the infant's typical diet. However, we lack research on rheological properties of frequently used infant formulas or breastmilk, and various forms of barium contrast media used in swallow studies. The aim of the current study was to provide objective viscosity measurements for typical infant liquid diet options and barium contrast media. A TA-Instruments AR2000 Advanced Rheometer was used to measure the viscosity of five standard infant formulas, three barium products, and two breastmilk samples. Additionally, this study measured the viscosity of infant formulas and breastmilk when mixed with powdered barium contrast in a 20 % weight-to-volume (w/v) concentration. The study findings determined that standard infant formulas and the two breastmilk samples had low viscosities, at the lower end of the National Dysphagia Diet (NDD) thin liquid range. Two specialty formulas tested had much thicker viscosities, close to the lower boundary of the NDD nectar-thick liquid range. The study showed differences in viscosity between 60 % w/v barium products (Liquid E-Z-Paque(®) and E-Z-Paque(®) powder); the powdered product had a much lower viscosity, despite identical barium concentration. When E-Z-Paque(®) powdered barium was mixed in a 20 % w/v concentration using water, standard infant formulas, or breastmilk, the resulting viscosities were at the lower end of the NDD thin range and only slightly thicker than the non-barium comparator liquids. When E-Z-Paque(®) powdered barium was mixed in a 20 % w/v concentration with the two thicker specialty formulas (Enfamil AR 20 and 24 kcal), unexpected alterations in their original viscosity occurred. These findings highlight the clinical importance of objective measures of viscosity as well as objective data on how infant formulas or breastmilk may change in consistency when mixed with barium.
在评估婴儿吞咽情况时，至关重要的是要确信吞咽研究中所使用的液体能够紧密复制婴儿日常饮食中液体的黏度。然而，我们缺乏关于常用婴儿配方奶粉或母乳以及吞咽研究中使用的各种形式钡剂造影剂流变学特性的研究。本研究的目的是为典型的婴儿液体饮食选择和钡剂造影剂提供客观的黏度测量值。使用TA仪器公司的AR2000高级流变仪测量了五种标准婴儿配方奶粉、三种钡剂产品和两份母乳样本的黏度。此外，本研究还测量了婴儿配方奶粉和母乳与粉末状钡剂造影剂按20%重量/体积（w/v）浓度混合后的黏度。研究结果表明，标准婴儿配方奶粉和两份母乳样本的黏度较低，处于国家吞咽困难饮食（NDD）稀液体范围的下限。测试的两种特殊配方奶粉的黏度要高得多，接近NDD花蜜状浓稠液体范围的下限。研究显示60% w/v钡剂产品（Liquid E-Z-Paque®和E-Z-Paque®粉末）之间的黏度存在差异；尽管钡浓度相同，但粉末状产品的黏度要低得多。当E-Z-Paque®粉末状钡剂按20% w/v浓度与水、标准婴儿配方奶粉或母乳混合时，所得黏度处于NDD稀范围的下限，仅比无钡对照液体略稠。当E-Z-Paque®粉末状钡剂按20% w/v浓度与两种较稠的特殊配方奶粉（美赞臣AR 20和24千卡）混合时，其原始黏度发生了意想不到的变化。这些发现突出了黏度客观测量的临床重要性，以及关于婴儿配方奶粉或母乳与钡混合时稠度可能如何变化的客观数据。
