Dear all:

The indicator that you may use for a DIAGNOSIS of RISK is not always the same indicator 
that you will use as an indicator of RESPONSE to an INTERVENTION.  

For instance, back in the 1970s there were many indicators of risk for low birth weight -- 
one of them being nutritional status.  On the basis of ONE indicator of risk, a rather large 
intervention trial was undertaken whereby they supplemented pregnant women with a 
high protein supplement.  Lo and behold they not only didn't see a positive response in 
birth weights -- those that were supplemented with protein actually had a worse outcome.  
Why?  Because they didn't screen for poor nutritional intake as a risk factor.  They 
screened for prior low birth weight.  Many of the women had OTHER risk factors that 
were probably contributing to low birth weight and the intervention wasn't appropriate.

Having watched the videofluoroscopy, I have no doubt about its ability to detect 
aspiration in bottle feeding infants.  It may also be true that you can nicely show less 
aspiration when FEEDING FROM A BOTTLE that there is less aspiration with thickener.  
What I have not seen shown is whether the risk of aspiration from feeding from a bottle 
with either is more or less than simply feeding from the breast and whether having the 
baby properly positioned at the breast to minimize risk of aspiration would have a similar 
or a better impact.  In terms of risks of infections and death, which we know is higher in 
infants fed something other than breast milk,  I don't know of any study that has looked 
into the impact of thickeners on these infants compared with any benefits of using 
thickener versus proper positioning at the breast.

Again, having watched those videoflurorscopes I do believe that the observations are 
correct about aspiration, but I have not yet seen evidence-based proof that the 
intervention of using a thickener is better than feeding at the breast in positions that 
minimize aspiration because I haven't seen studies that do the videofluoroscope when an 
infant is feeding at the breast.  Nor have I seen any study that investigates the benefits 
and weighs these against other potential harm.  In dealing with seriously compromised 
babies it is ALWAYS challenging and because infants with these problems are far less 
common it is very hard to the proper research to prove that one intervention is better 
than another.  And so often we are stuck with going with the intervention for which we 
have a plausible rationale that it works better.


Best, Susan Burger

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