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Perinatal/Neonatal Case Presentation

Development of necrotizing enterocolitis in premature infants receiving thickened feeds using SimplyThick®


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.

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  1. Sharp K, Ward L, Cichero J, Sopade P, Halley P . Thickened fluids and water absorption in rats and humans. Dysphagia 2007; 22: 193–203.

    Article  Google Scholar 

  2. 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.

    Article  CAS  Google Scholar 

  3. Eastwood MA, Brydon WG, Anderson DMW . The dietary effects of xanthan gum in man. Food Addit Contam 1987; 4 (1): 17–26.

    Article  CAS  Google Scholar 

  4. Neu J, Walker WA . Necrotizing enterocolitis. N Engl J Med 2011; 364 (3): 255–264.

    Article  CAS  Google Scholar 

  5. 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.

    Article  CAS  Google Scholar 

  6. 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.

    Article  CAS  Google Scholar 

  7. 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.

    Article  CAS  Google Scholar 

  8. 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.

    Article  CAS  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. 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.

    Article  CAS  Google Scholar 

  11. Lin J . Too much short chain fatty acids cause neonatal necrotizing enterocolitis. Med Hypotheses 2004; 62: 291–293.

    Article  CAS  Google Scholar 

  12. 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.

    Article  CAS  Google Scholar 

  13. Martin CR, Walker WA . Intestinal immune defences and the inflammatory response in necrotising enterocolitis. Semin Fetal Neonatal Med 2006; 11: 369–377.

    Article  Google Scholar 

  14. 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.

    Article  CAS  Google Scholar 

  15. 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.

    Article  CAS  Google Scholar 

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We thank Dr Michael O’Shea for his critical reading of this manuscript.

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Correspondence to Q Yang.

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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).

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  • necrotizing enterocolitis
  • dysphagia
  • premature infant
  • SimplyThick®
  • thickened feeds
  • xanthan gum

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