SimplyThick®(ST) has been safely used as a thickener to treat adults who have dysphagia, but the safety of this product has not been studied in premature infants. Xanthan gum is the ingredient in ST that results in thickening and also is an effective laxative. We recently began using ST to treat premature infants with dysphagia and/or gastroesophageal reflux. We describe three cases of premature infants who developed necrotizing enterocolitis (NEC) after they were fed ST. Unlike classic NEC, all three cases presented with late-onset colonic NEC.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety
Nutrition Journal Open Access 01 May 2013
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
Sharp K, Ward L, Cichero J, Sopade P, Halley P . Thickened fluids and water absorption in rats and humans. Dysphagia 2007; 22: 193–203.
Woodard G, Woodard MW, McNeely WH, Kovacs P, Cronin MTI . Xanthan gum: safety evaluation by two-year feeding studies in rats and dogs and a three-generation reproduction study in rats. Toxicol Appl Pharmacol 1973; 24 (1): 30–36.
Eastwood MA, Brydon WG, Anderson DMW . The dietary effects of xanthan gum in man. Food Addit Contam 1987; 4 (1): 17–26.
Neu J, Walker WA . Necrotizing enterocolitis. N Engl J Med 2011; 364 (3): 255–264.
Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL . Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1991; 119: 630–638.
Adiotomre J, Eastwood MA, Edwards CA, Brydon WG . Dietary fiber: in-vitro methods that anticipate nutrition and metabolic activity in humans. Am J Clin Nutr 1990; 52: 128–134.
Daly J, Tomlin J, Read NW . The effect of feeding xanthan gum on colonic function in man: correlation with in vitro determinants of bacterial breakdown. Br J Nutr 1993; 69: 897–902.
Trout DL, Ryan RO, Bickard MC . The amount and distribution of water, dry matter, and sugars in the digestive tract of rat fed xanthan gum. Proc Soc Exp Biol Med 1983; 172: 340–345.
Edwards CA, Eastwood MA . Caecal and fecal short-chain fatty acids and stool output in rats fed on diets containing non-starch polysaccharides. Br J Nutr 1995; 73: 773–781.
Nafday SM, Chen W, Peng L, Babyatsky MW, Holzman IR, Lin J . Short-chain fatty acids induce colonic mucosal injury in rats with various postnatal ages. Ped Res 2005; 57 (2): 201–204.
Lin J . Too much short chain fatty acids cause neonatal necrotizing enterocolitis. Med Hypotheses 2004; 62: 291–293.
Halpern MD, Holubec H, Saunders TA, Dvorak K, Clark JA, Doelle SM et al. Bile acids induce ileal damage during experimental necrotizing enterocolitis. Gastroenterology 2006; 130 (2): 359–372.
Martin CR, Walker WA . Intestinal immune defences and the inflammatory response in necrotising enterocolitis. Semin Fetal Neonatal Med 2006; 11: 369–377.
Ishizaka S, Sugawara I, Hasuma T, Morisawa S, Möller G . Immune response to xanthan gum I. The characteristics of lymphocyte activation by xanthan gum. Eur J Immunol 1983; 13: 225–231.
Takeuchi A, Kamiryou Y, Yamada H, Eto M, Shibata K, Kennichi H et al. Oral administration of xanthan gum enhances antitumor activity through Toll-like receptor 4. Int Immunopharmacol 2009; 9: 1562–1567.
We thank Dr Michael O’Shea for his critical reading of this manuscript.
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Woods, C., Oliver, T., Lewis, K. et al. Development of necrotizing enterocolitis in premature infants receiving thickened feeds using SimplyThick®. J Perinatol 32, 150–152 (2012). https://doi.org/10.1038/jp.2011.105
- necrotizing enterocolitis
- premature infant
- thickened feeds
- xanthan gum
This article is cited by
Verwendung von diätetischen Lebensmitteln für besondere medizinische Zwecke („bilanzierte Diäten“) für Säuglinge, Aktualisierung 2022
Monatsschrift Kinderheilkunde (2022)
Thickened Liquids Using Pureed Foods for Children with Dysphagia: IDDSI and Rheology Measurements
Clinical Aspects of Thickeners for Pediatric Gastroesophageal Reflux and Oropharyngeal Dysphagia
Current Gastroenterology Reports (2019)
Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm Infants with Dysphagia: A Pilot Study
Rheological Behaviors of Thickened Infant Formula Prepared with Xanthan Gum-Based Food Thickeners for Dysphagic Infants