Tolerance and Acceptability of a New Paediatric Enteral Tube Feeding Formula Containing Ingredients Derived From Food: A Multicentre Trial In The United Kingdom

Recently, as reported by dietetic departments in the United Kingdom, we have seen an increase in Homemade Blended Diets (HBD) being given to children requiring tube feeding. HBD practice may increase the risk of tube occlusion and nutritional inadequacies. In 2015 the British Dietetic Association (BDA) developed their first ‘Practice toolkit liquidised food via gastrostomy tube’, which did not recommend administration of liquidised food via an enteral feeding tube. The BDA has recently updated its position statement, facilitating a more open discussion with patients and carers on blenderised diets and empowering dietitians to feel professionally supported.

A tube feed formula has been developed to address safety and nutritional inadequacies. Study design followed UK Advisory Committee on Borderline Substances (ACBS) criteria to support submission for prescription usage in the National Health Service (NHS). All participants (n=19) were tube fed, recruited from NHS settings and under the care of a dietitian/doctor. All were given the new formula for 7 days, Isosource Junior Mix, Nestlé Health Science. Demographic and medical data was obtained and gastrointestinal (GI) tolerance recorded; stool type was measured using the Bristol Stool Chart

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Clare Thornton-Wood

Tolerance and Acceptability of a Low-Calorie Paediatric Peptide Enteral Tube Formula: A Multicentre Trial in the United Kingdom

Medical Speciality

The prevalence of Cerebral Palsy (CP) children who require a low-calorie feed is between 8-15%. ESPGHAN working group recommend using a low-fat, low-calorie, high fibre, micronutrient replete formula for immobile Neurological Impaired children.

Children aged 1-11 years with neurological issues were recruited from UK National Health Service (NHS). Participants were given the new low-calorie enteral tube feed formula with fibre (Peptamen Junior 0.6 kcal/ml, Nestlé Health Science) over a 7-day period.

Formula intake and gastro-intestinal tolerance was recorded. Seven out of 9 completed the 7-day trial. One child withdrew from the study due to slight increase in flatulence (the child was previously on a non-fibre containing feed). One child suspended the feed on day 3 due to user error. The average daily formula intake was 1032mls (600-1300ml) for those completing the trial and tolerated 100% of the low-calorie formula. One child saw increase in stool frequency (usually type 6) from 2 to 4 times per day and a slight increase in flatulence and bloating; it was noted this child was also previously on a non-fibre containing feed and suggest a slow introduction of fibre containing formula in children who are sensitive could be beneficial. The new low-calorie formula was well tolerated by the majority of participants. This formula could be useful to ensure full nutritional goals are met for those children with low energy needs.

You can download the article here

Clare Thornton-Wood

Performance-based preference for a novel xanthan gum-based thickener among clinicians treating dysphagia patients

Medical Speciality
Herentry K, et al. European Geriatric Medicine. 2011;2(S24-S206.).

Excellent Compliance1:
Does not affect colour, taste and odour of hot or cold liquids or foods.
  • Flavourless & Odourless
  • No lumps in various liquids
  • Practically transparent in water

  • 98% of professionals state that it helps improve compliance*



    Easy to Prepare6
    The results obtained with Resource® ThickenUp® Clear, Achieves a uniform level of viscosity in all hot or cold liquids.
  • Dissolves rapidly in all liquids
  • Same quantity for a given level of viscosity in all liquids

  • 8/10 professionals like how It prepares the right in-mouth consistency22



    Improve Swallowing Safety2-5
    Allows more effective treatment of swallowing difficulties.
  • Uniform viscosity, stable over time:
    Form a bolus without residues2
    Withstands salivary amylase3,7
    No over-thickening with time7
  • Fewer penetrations and aspirations2-4
  • Reduces the amount of oral and pharyngeal residue as compared to a starch-based thickening agent3

  • 80% of professionals prefer it over the thickening agents they recommended before6





    REFERENCES
    1. Effects of bolus rheology on aspiration in patients with dysphagia. Leonard RJ et al. J Acad Nutr Diet. 2014; 114(4): 590–594
    2. A comparative study between modified starch and xanthan gum thickeners in post stroke oropharyngeal dysphagia. Vilardell N et al. Dysphagia 2016; 31(2): 169–179
    3. The effects of a xanthan gum based thickener on the swallowing function of patients with dysphagia. Rofes L et al. Aliment Pharmacol Ther. 2014; 39(10): 1169–1179 4. Matching the rheological properties of videofluoroscopic contrast agents and thickened liquid prescriptions. Popa Nita S et al. Dysphagia 2013; 28(2): 245–252
    5. Acceptance, compliance and tolerance of a novel xanthan gum based thickener on oropharyngeal dysphagia patients. Hibberd J et al. Dysphagia 2011; 26: 432–475
    6. Performance-Based Preference for a Novel Xanthan Gum-Based Thickener among Clinicians Treating Dysphagia Patients. Nestlé Research Centre. Data on file 2011.
    7. Method of measuring amylase resistance properties of Resource® ThickenUp® Clear and a leading Thickening agent. Nestlé Research Center. Data on file 2009.
    Herentry K, et al

    Sensitivity and Specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for Clinical Evaluation of Oropharyngeal Dysphagia

    Medical Speciality
    Rofes L, Arreola V, Mukherjee R, Clavé P Neurogastroenterol Motil 2014 Sep;26:1256-65.

    Aim:
    To re-validate the accuracy of the Volume-Viscosity Swallow Test (V-VST) for Clinical Assessment by using a new thickening agent with an exclusive formula (ThickenUp® Clear) on 120 patients with oropharyngeal dysphagia associated with age and neurological pathology.

    Results:
    The study showed the V-VST using ThickenUp® Clear has high sensitivity in detecting patients with swallowing difficulty
  • Sensitivity of 0.94 and specificity of 0.88 in detecting oropharyngeal dysphagia
  • Sensitivity of 0.79 and specificity of 0.75 in detecting impaired efficacy
  • Sensitivity of 0.87 and specificity of 0.81 in detecting impaired safety
  • Sensitivity of 0.91 and specificity of 0.28 in detecting aspirations


  • Figure 12
    Test flow.


    Conclusion
    The V-VST is a validated method of Clinical Assessment of dysphagia, a sequence of 3 sizes of bolus of 3 different viscosities thickened with ThickenUp® Clear, is reliable in detecting and guiding management of patients with oropharyngeal dysphagia.
    Rofes L, et al

    Human Milk Oligosaccharides: New Ways to Shape the Gut Microbiome in Cows’ Milk Protein Allergy

    Medical Speciality
    Prof O’Mahony began by discussing how the human gut is colonised by a wide diversity of microbes. He went on to review the evidence for how they exhibit highly evolved synergistic relationships to provide essential biological functions to the host and how the gut microbiome is influenced by many factors in early life.
    Prof Renz proceeded to describe the importance of establishing a stable gut microbial community, which closely tracks host growth and immune development. The mechanisms whereby delays or alterations in the establishment of these communities can lead to microbiome immaturity, raise the risk of allergy development including cow’s milk protein allergy (CMPA).
    Dr Forbes-Blom introduced the multiplicity of human milk oligosaccharides (HMO) and explained their position as multifunctional components that shape the developing gut microbiome and influence the developing immune system.
    Finally, Prof Nowak Wegrzyn reviewed the latest trial data on supplementing specialty formulas for the management of CMPA with different HMO and reported the results.

    Read the full symposium notes here.






    IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their infants have cows’ milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cows’ milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to give instructions on correct preparation methods, emphasising that unboiled water, unsterilised bottles or incorrect dilution can all lead to illness. Formula for special medical purposes intended for infants must be used under medical supervision.
    Professor Liam O'Mahony
    Dr Harald Renz
    Dr Elizabeth Forbes-Blom
    Professor Ann Nowak-Wergrzyn

    Nestlé Health Science Scientific Publications Compendium 2018

    In 2018, Nestlé Health Science contributed to a number of scientific publications covering a broad spectrum of clinical conditions. We are now pleased to share with you this booklet, which summarises these publications as well as those contributed by the worldwide scientific community.

    As an innovative health science company, NHSc strongly believes in leveraging and investing in leading-edge science. We strive to forge a new industry, based on inherently safe nutritional therapies, which improve quality of life and provide clinical and health economic value. Our aim is to maximise the role of nutrition in empowering healthier lives.

    We also take this opportunity to thank all the experts involved in this work, namely healthcare professionals, institutions and Nestlé Health Science colleagues.

    Read the Scientific Compendium here
    Nestlé Health Science

    Hypoallergenicity of A Whey-Based, Extensively Hydrolysed Formula Containing Two Structurally Identical Human Milk Oligosaccharides

    Medical Speciality
    Abstract:
    To determine whether an extensively hydrolyzed formula (EHF) supplemented with two human milk oligosaccharides (HMO) was tolerated by infants with cow’s milk protein allergy (CMPA).

    Methods:
    A whey-based EHF (Test formula) containing 2′fucosyl-lactose (2′FL) and lacto-N-neotetraose (LNnT) was assessed for clinical hypoallergenicity and safety. The Control formula was a currently marketed EHF without HMO. Children with CMPA, aged 2 months to 4 years, were assessed by double-blind, placebo-controlled food challenges (DBPCFC) to both formulas, in randomized order. If both DBPCFC were negative, subjects participated in a one-week, open food challenge (OFC) with the Test formula. Symptoms and adverse events were recorded. Hypoallergenicity was accepted if at least 90% (with 95% confidence intervals) of subjects tolerated the Test formula.

    Results:
    Of the 82 children with CMPA that were screened, 67 (intention-to-treat [ITT] cohort—mean age 24.5 ± 13.6 months; range 2–57; 45 [67.2%] male) were randomized to receive either the Test or the Control formula during the first DBPCFC. Of these, 64 children completed at least one DBPCFC (modified intention-to-treat [mITT] cohort). Three children were excluded due to protocol deviations (per protocol [PP] cohort; n = 61). There was one allergic reaction to the Test, and one to the Control formula. On the mITT analysis, 63 out of 64 (98.4%; 95% CI lower bound 92.8%), and on the PP analysis 60 out of 61 (98.4%; 95% CI lower bound 92.5%) participants tolerated the Test formula, confirming hypoallergenicity.

    Conclusion:
    The whey-based EHF supplemented with 2′FL and LNnT met the clinical hypoallergenicity criteria and can be recommended for the management of CMPA in infants and young children.

    Read more about the clinical trial here





    Reference:
    1. Hypoallergenicity of a whey-based, extensively hydrolysed infant formula containing two human milk oligosaccharides: Anna Nowak-Wegrzyn, Laura Czerkies, Kemuel Reyes, Barbara Collins, Ralf G. Heine. Abstract presented at the annual EAACI congress in Lisbon June 1-5, 2019.






    IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their infants have cows’ milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cows’ milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to give instructions on correct preparation methods, emphasising that unboiled water, unsterilised bottles or incorrect dilution can all lead to illness. Formula for special medical purposes intended for infants must be used under medical supervision.
    Professor Anna Nowak-Wegrzyn
    Dr Laura Czerkies
    Kemuel Reyes
    Dr Barbara Collins
    Dr Ralf G. Heine

    The Cows' Milk Allergy-Related Symptoms Score (CoMiSS™): A Useful Tool in the Clinical Setting - Results from an Observational Study

    Medical Speciality
    Objectives and Study:
    The CoMiSS score was developed as an easy-to-use awareness tool for primary health care providers to increase the awareness of the most common symptoms of cow's milk protein allergy (CMPA) and the evolution of symptoms during a therapeutic intervention. The purpose of the study was to evaluate the score in infants with symptoms indicative of CMPA and to evaluate its usefulness in the clinical practice.

    Methods:
    The study took place in 4 European countries (Belgium (BE), Czech Republic (CZ), Germany (GER), United-Kingdom (UK)) and the dietary intervention was according to the current practice of the participating HCP in order to obtain “real world data”. CoMiSS was determined in 268 infants and young children (145 boys, 117 girls) aged 0-18 months at the first visit upon presenting symptoms suggesting CMPA and again after 3 weeks of a dietary intervention, with a cow milk protein free diet.

    Results:
    The characteristics, of the infants included, differed according to the country at first visit for age in weeks [mean ± SD] (12.7 ± 10.0 for BE; 24.1 ±14.2 for CZ; 21.4 ± 17.7 for GER; 34.1 ± 17.7 for UK) and duration of symptoms in weeks [mean ±SD] (6.9 ± 9.1 for BE, 11.5 ±10.4 for CZ, 9.7 ± 12.4 for GER and 24.0 ± 15.4 for UK ) In all countries, weight and height were in line with the reference growth chart and no growth failure was recorded before diagnosis. The median (IQR) CoMiSS score at inclusion was 11 (8-14) overall, 11 (8-14) in BE, 13 (12-16) in CZ, 8 (6-10) in GER and 7 (4-10) in UK. After 3 weeks of intervention per routine prescription the median (IQR) CoMiSS scores was 4 (2-6) and per country: BE 4 (2-6), CZ 3 (2-5), GER 4 (2-6), UK 3 (1-6). The scores after 3 weeks are in line with those considered as normal in healthy infants. At the first visit, 145/268 were prescribed medication for their symptoms with 35 (13%) taking one or more antacids. Additional medication was prescribed in 48 (18%), including 8 given a new prescription for an antacid. Data were analyzed per Intention to Treat and Per Protocol without notable differences.

    Conclusions:
    This study confirms that CoMiSS is a useful tool to increase the awareness of CMPA "in real life". Differences were noted between the four countries.




    Reference
    The cow's milk-related symptoms score (CoMiSS™): a useful tool in the clinical setting - results from an observational study. Yvan Vandenplas, Elisabeth Belsey, Anette Jarvi, Philippe Steenhout. Abstract presented at the annual ESPGHAN congress, June 6. JPGN Volume 68, Supplement 1, May 2019.






    IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their infants have cows’ milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cows’ milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to give instructions on correct preparation methods, emphasising that unboiled water, unsterilised bottles or incorrect dilution can all lead to illness. Formula for special medical purposes intended for infants must be used under medical supervision.
    Professor Yvan Vandenplas
    Elisabeth Belsey
    Dr Anette Jarvi
    Dr Philippe Steenhout