{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:10:44Z","timestamp":1790817044896,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,7,10]],"date-time":"2018-07-10T00:00:00Z","timestamp":1531180800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["P01 DK068051"],"award-info":[{"award-number":["P01 DK068051"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R25 HD086885"],"award-info":[{"award-number":["R25 HD086885"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Background<\/jats:italic>\n                    : A common osmolality threshold for feedings is to stay &lt;450\u00a0mOsm\/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\u2010to\u2010feed preterm formulas are unclear. Our aims were to evaluate and compare the effects of caloric density, thickening agent recipes, and supplements to ready\u2010to\u2010feed preterm formula on osmolality.\n                    <jats:italic>Methods<\/jats:italic>\n                    : A freezing point osmometer was used to measure the osmolality of 47 preterm infant formula combinations with varying caloric densities (ready\u2010to\u2010feed 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\u2010\u03bcL pipette. Comparisons were made using analysis of variance and\n                    <jats:italic>t<\/jats:italic>\n                    \u2010tests for group and pair\u2010wise comparisons, respectively.\n                    <jats:italic>Results<\/jats:italic>\n                    : A total of 470 osmolality samples were analyzed: (1) raters had high agreement (\n                    <jats:italic>r<\/jats:italic>\n                    = 0.98;\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0&lt;\u00a0.001); (2) for every 0.5 tsp\/oz of thickener, the osmolality increases by 30\u00a0mOsm\/kg (\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0&lt;\u00a0.001); (3) osmolality was higher with the oatmeal (vs rice) thickening agent (\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0&lt;\u00a0.001); and (4) vitamin and electrolyte supplement combinations increase osmolality.\n                    <jats:italic>Conclusions<\/jats:italic>\n                    : Alteration of ready\u2010to\u2010feed preterm formulas may significantly increase osmolality and have unintended consequences. Caution and monitoring should be exercised with modifying ready\u2010to\u2010feed 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.\n                  <\/jats:p>","DOI":"10.1002\/jpen.1418","type":"journal-article","created":{"date-parts":[[2018,7,10]],"date-time":"2018-07-10T23:30:11Z","timestamp":1531265411000},"page":"290-297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["The Effect of Additives for Reflux or Dysphagia Management on Osmolality in Ready\u2010to\u2010Feed Preterm Formula: Practice Implications"],"prefix":"10.1002","volume":"43","author":[{"given":"Deborah S.","family":"Levy","sequence":"first","affiliation":[{"name":"Speech and Language Pathology Health and Communication Department Universidade Federal do Rio Grande do Sul  Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Osborn","sequence":"additional","affiliation":[{"name":"Innovative Infant Feeding Disorders Research Program The Research Institute at Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Hasenstab","sequence":"additional","affiliation":[{"name":"Innovative Infant Feeding Disorders Research Program The Research Institute at Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saira","family":"Nawaz","sequence":"additional","affiliation":[{"name":"Innovative Infant Feeding Disorders Research Program The Research Institute at Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudarshan R.","family":"Jadcherla","sequence":"additional","affiliation":[{"name":"Innovative Infant Feeding Disorders Research Program The Research Institute at Nationwide Children's Hospital  Columbus Ohio USA"},{"name":"Divisions of Neonatology Pediatric Gastroenterology and Nutrition Department of Pediatrics The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2011.300492"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-879X2002000200010"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/fn.81.2.F141"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2015.00056"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000454667"},{"issue":"2","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1542\/peds.57.2.278","article-title":"Commentary on breast\u2010feeding and infant formulas including proposed standards formulas","volume":"57","author":"Barness LA","year":"1976","journal-title":"Pediatrics"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-2576"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-0420"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607114558303"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001831"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2013-304650"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000381361"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2003.tb00607.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0b013e32832b36fe"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-984723"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(03)00068-X"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2008.09.011"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30552-4"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3181b7f563"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.96.2.331"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607114552848"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnn.2015.07.004"},{"issue":"7","key":"e_1_2_9_24_1","first-page":"23","article-title":"Be cautious in using thickening agents for preemies","volume":"32","author":"Abrams S.","year":"2011","journal-title":"AAP News"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-014-9523-z"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-28032015000100007"},{"issue":"11","key":"e_1_2_9_27_1","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1007\/BF01540041","article-title":"Modulation of esophageal peristalsis by alterations of body position. 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