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Related Experiment Videos

Hypertonic formula resulting from added oral medications.

K C White, K L Harkavy

    American Journal of Diseases of Children (1960)
    |October 1, 1982
    PubMed
    Summary

    Oral elixirs, like calcium glubionate, significantly increase infant formula osmolality, posing a risk for necrotizing enterocolitis in premature infants. Intravenous preparations are a safer alternative due to lower osmolality.

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    Area of Science:

    • Neonatal Medicine
    • Pediatric Pharmacology
    • Clinical Pharmacy

    Background:

    • Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition affecting premature infants.
    • Medications administered orally to neonates can alter gastrointestinal physiology.
    • The osmolality of enteral feeds is a critical factor in neonatal gut health.

    Observation:

    • A premature infant developed necrotizing enterocolitis after receiving calcium glubionate elixir in feedings.
    • The osmolality of several common oral elixirs (theophylline, phenobarbital, dexamethasone, digoxin) was significantly higher than their intravenous counterparts.
    • Mixing oral elixirs like dexamethasone and phenobarbital with infant formula drastically increased formula osmolality.

    Findings:

    • Oral elixir preparations, particularly dexamethasone and phenobarbital, markedly increase formula osmolality when administered in clinically relevant doses.
    • The osmolality increase in formula-drug mixtures can exceed 300% compared to formula alone.
    • The osmolality impact of digoxin, theophylline, and calcium glubionate elixirs on formula was less pronounced but still notable.

    Implications:

    • High osmolality from oral elixirs may contribute to the pathogenesis of necrotizing enterocolitis in vulnerable premature infants.
    • Switching to intravenous formulations or using lower osmolality oral preparations may mitigate NEC risk.
    • Healthcare providers should carefully consider medication formulation and osmolality when prescribing for premature neonates.

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