Regarding neonates and infants, the videofluoroscopy swallowing study is always conducted with liquids impregnated with a radiopaque material in varied proportions and thickenings. Variations in thickening and barium concentration are known to change the swallowing function. The present study aimed to analyze the rheological and macroscopic properties of barium contrast and liquids commonly used in Brazil with infants under six months old. This study was approved by the Ethics Committee under certificate number 63361616.2.0000.5482. Rheological measurements were performed on samples of breast milk and infant formulas, pure, with thickener, impregnated with liquid barium sulfate, as well as a pure barium sulfate sample. The data collected showed similar viscosity rates between breast milk and the infant formulas Aptamil and Enfamil. Impregnating them with 20% and 33% liquid barium sulfate increased their viscosity. However, they remained in the same classification, despite the quantitative differences in their apparent viscosity. The regular products, in formulation with thickener and thickener plus 20% barium, showed an increase in apparent viscosity close or twice to that of Enfamil A.R. impregnated with 33% barium sulfate. The study allowed a more in-depth understanding of how the products behave at strain rates consistent with the conditions when swallowing. The results indicated in this study confirm the need for knowledge and care in preparing liquids to be offered in videofluoroscopy swallowing studies with neonates and infants. They also emphasize the importance of objectively measuring the viscosities of videofluoroscopic fluids, matching them with the liquids to be prescribed in their diets.
Almeida M, Almeida J, Moreira M, Novak F. Adequacy of human milk viscosity to respond to infants with dysphagia: Experimental study. Journal of Applied Oral Science. 2011;(6):554–9.
2.
Arvedson J. Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. Developmental Disabilities Research Reviews. 2008;(2):118–27.
3.
Atala D, Costa A, Maciel R, Maugeri F. Kinetics of ethanol fermentation with high biomass concentration considering the effect of temperature. Applied Biochemistry and Biotechnology. 2001;353.
4.
Bae S, Lee G, Seo H, Oh BM, Han T. Clinical characteristics associated with aspiration or penetration in children with swallowing problem. Annals of Rehabilitation Medicine. 2014;(6):734–41.
5.
Ijfs M. Breast milk and formula -rheological behavior 19. 2024;1–21.
6.
Barbon C, Steele C. Characterizing the flow of thickened barium and non-barium liquid recipes using the IDDSI flow test. Dysphagia. 2019;(1):73–9.
7.
Baron J, Alexander T. Effects of powdered versus liquid barium on the viscosity of fluids used in modified swallow studies. Canadian Association of Radiologists Journal. 2003;(3):152–4.
Cichero J, Nicholson, Dodrill P. Liquid barium is not representative of infant formula: Characterisation of rheological and material properties. Dysphagia. 2011;(3):264–71.
10.
Cichero J, Lam P, Steele C, Hanson B, Chen J, Dantas R, et al. Development of international terminology and definitions for texturemodified foods and thickened fluids used in dysphagia management: The IDDSI framework. Dysphagia. 2017;(2):293–314.
11.
Dantas R, Dodds W, Massey B, Kern M. The effect of highvs low-density barium preparations on the quantitative features of swallowing. American Journal of Roentgenology. 1989;(6):1191–5.
12.
De La Fuente E, Turcanu M, Ekberg O, Gallegos C. Dysphagia: Diagnosis and treatment. 2019;119.
13.
Duncan D, Larson K, Rosen R. Clinical aspects of thickeners for pediatric gastroesophageal reflux and oropharyngeal dysphagia. Current Gastroenterology Reports. 2019;(7).
14.
Ekberg O, Stading M, Johansson D, Bülow M, Ekman S, Wendin K. Flow properties of oral contrast medium formulations depend on the temperature. Acta Radiologica. 2010;(4):363–7.
15.
Fink T, Ross J. Are we testing a true thin liquid? Dysphagia. 2009;(3):285–9.
16.
Frazier J, Chestnut A, Jackson A, Barbon C, Steele C, Pickler L. Understanding the viscosity of liquids used in infant dysphagia management. Dysphagia. 2016;(5):672–9.
17.
From A, Al Badarin F, Mcdonald F, Bartholmai B, Cha S, Rihal C. Iodixanol versus lowosmolar contrast media for prevention of contrast induced nephropathy: Metaanalysis of randomized, controlled trials. Circulation. 2010;(4):351–8.
18.
Geddes D, Sakalidis V, Hepworth A, Mcclellan H, Kent J, Lai C, et al. Tongue movement and intra-oral vacuum of term infants during breastfeeding and feeding from an experimental teat that released milk under vacuum only. Early Human Development. 2012;(6):443–9.
19.
Gosa M, Dodrill P. Effect of time and temperature on thickened infant formula. Nutrition in Clinical Practice. 2017;(2):238–44.
20.
Hanson B, Jamshidi R, Redfearn A, Begley R, Steele C. mental and computational investigation of the IDDSI flow test of liquids used in dysphagia management. Annals of Biomedical Engineering. 2019;(11):869–79.
21.
Hernandez A, Berto M, Bianchini E. Article e14910. 2020;(12).
22.
Hernandez A, Bianchini E. Swallowing analyses of neonates and infants in breastfeeding and bottlefeeding: Impact on videofluoroscopy swallow studies. International Archives of Otorhinolaryngology. 2019;(3):343-e353.
23.
Kuhlemeier K, Palmer J, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;(2):119–22.
24.
Lefton-Greif M, Mcgrattan K, Carson K, Pinto J, Wright J, Martin-Harris B. First steps towards development of an instrument for the reproducible quantification of oropharyngeal swallow physiology in bottle-fed children. Dysphagia. 2018;(1):76–82.
25.
Leonard R, White C, Mckenzie S, Belafsky P. Effects of bolus rheology on aspiration in patients with dysphagia. Journal of the Academy of Nutrition and Dietetics. 2014;(4):590–4.
26.
Logemann J, Williams R, Rademaker A, Pauloski B, Lazarus C, Cook I. The relationship between observations and measures of oral and pharyngeal residue from videofluorography and scintigraphy. Dysphagia. 2005;(3):226–31.
27.
National dysphagia diet: Standardization for optimal care. 2002;
28.
Queiroz C, Barros S, Borgo H, Marino V, Dutka J. Viscosidade e qualidade da imagem do líquido espessado para videodeofluoroscopia de deglutição com acréscimo do contraste de bário. Revista CEFAC. 2015;(3):879–89.
29.
Robertson H, Pattillo M. A strategy for providing food to the patient with neurologically based dysphagia. Journal of the Canadian Dietetic Association. 1993;198–201.
30.
September C, Nicholson T, Cichero J. Implications of changing the amount of thickener in thickened infant formula for infants with dysphagia. Dysphagia. 2014;(4):432–7.
31.
Siddiqui M, Litts J, Cheney D, Kuhn M, Nativ-Zeltzer N, Belafsky P. The effect of aspirated barium sulfate, iodixanol, and diatrizoic acid on survival and lung injury in a lagomorph model. The Laryngoscope. 2017;(5):148-E152.
32.
Steele C, Alsanei W, Ayanikalath S, Barbon C, Chen J, Cichero J, et al. The influence of food texture and liquid consistency modification on swallowing physiology and function: A systematic review. Dysphagia. 2015;(1):2–26.
33.
Steffe J. Rheological methods in food process engineering. 1996;(2).
34.
Stokely S, Molfenter S, Steele C. Effects of barium concentration on oropharyngeal swallow timing measures. Dysphagia. 2014;(1):78–82.
35.
Stuart S, Motz J. Viscosity in infant dysphagia management: Comparison of viscosity of thickened liquids used in assessment and thickened liquids used in treatment. Dysphagia. 2009;(4):412–22.
36.
Sukkar S, Maggi N, Travalca Cupillo B, Ruggiero C. Optimizing texture modified foods for oro-pharyngeal dysphagia: A difficult but possible target? 2018;
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
