Speech and Language Pathology, Health and Communication Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.
JPEN J Parenter Enteral Nutr. 2019 Feb;43(2):290-297. doi: 10.1002/jpen.1418. Epub 2018 Jul 10.
A common osmolality threshold for feedings is to stay <450 mOsm/kg for normal infants. Preterm formulas are frequently modified to improve growth, modify nutrition, and manage gastroesophageal reflux (GER) or dysphagia. Relationships between osmolality and additives to ready-to-feed preterm formulas are unclear. Our aims were to evaluate and compare the effects of caloric density, thickening agent recipes, and supplements to ready-to-feed preterm formula on osmolality.
A freezing point osmometer was used to measure the osmolality of 47 preterm infant formula combinations with varying caloric densities (ready-to-feed 22 and 30 cal/oz), thickening agents (rice vs oatmeal cereal), thickener amounts (0.0, 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 tsp/oz), and combinations of supplements (saline, iron, vitamin D, or multivitamin). Ten samples per combination were tested using a 10-μL pipette. Comparisons were made using analysis of variance and t-tests for group and pair-wise comparisons, respectively.
A total of 470 osmolality samples were analyzed: (1) raters had high agreement (r = 0.98; P < .001); (2) for every 0.5 tsp/oz of thickener, the osmolality increases by 30 mOsm/kg (P < .001); (3) osmolality was higher with the oatmeal (vs rice) thickening agent (P < .001); and (4) vitamin and electrolyte supplement combinations increase osmolality.
Alteration of ready-to-feed preterm formulas may significantly increase osmolality and have unintended consequences. Caution and monitoring should be exercised with modifying ready-to-feed preterm formulas for regurgitation, rumination, GER, dysphagia, feeding intolerance, or emesis. This study supports the concept of achieving volume tolerance before further manipulation of additives.
对于正常婴儿，喂养的常用渗透压阈值为<450mOsm/kg。早产儿配方通常经过改良以促进生长、改变营养成分，并管理胃食管反流（GER）或吞咽困难。渗透压与即用型早产儿配方中的添加剂之间的关系尚不清楚。我们的目的是评估和比较不同热量密度、增稠剂配方和补充剂对即用型早产儿配方渗透压的影响。
使用冰点渗透压计测量 47 种不同热量密度（即食 22 和 30 卡路里/盎司）、增稠剂（米粉与燕麦片）、增稠剂用量（0.0、0.5、1.0、1.5、2.0、2.5 和 3.0 茶匙/盎司）和补充剂组合（盐水、铁、维生素 D 或多种维生素）的即用型早产儿配方的渗透压。每种组合测试 10 个样本，使用 10μL 移液器进行测试。分别使用方差分析和 t 检验进行组间和两两比较。
共分析了 470 个渗透压样本：（1）评分者之间具有高度一致性（r = 0.98；P<0.001）；（2）每增加 0.5 茶匙/盎司增稠剂，渗透压增加 30mOsm/kg（P<0.001）；（3）燕麦片（而非米粉）增稠剂的渗透压更高（P<0.001）；（4）维生素和电解质补充剂组合会增加渗透压。
改变即用型早产儿配方可能会显著增加渗透压，并产生意想不到的后果。对于因反流、反刍、GER、吞咽困难、喂养不耐受或呕吐而修改即用型早产儿配方，应谨慎并进行监测。本研究支持在进一步添加添加剂之前先达到容量耐受的概念。
