What is Isosource^® Junior Mix?

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SmartFlex™ uses state-of-the-art design and production techniques to create innovative packaging for enteral feeds:

• Easy to use and administer
• Universal cap means SmartFlex™ fits all commonly used giving sets without an adaptor
• High quality design and production with closed system
• Collapsible semi-rigid packaging for compact and safe disposal
• Easy to administer for bolus feeding

Short bowel syndrome; intractable malabsorption; preoperative preparation of undernourished patients; inflammatory bowel disease; total gastrectomy; dysphagia; bowel fistulae; feeding intolerances, developmental disabilities, disease related malnutrition for children greater than 1 year of age.

Isosource® Junior Mix must be used under medical supervision. Only suitable for children older than 1 year of age. For enteral use only. Contains: milk and fish, therefore not suitable for those with a fish or cows’ milk allergy and/or galactosaemia. Do not mix food or medication with feed.

Suitable as a sole source of nutrition.

Nutritionally complete in:

• 1–3 years: 700ml*
• 4–6 years: 929ml*
• 7–10 years: 1000ml**
• 11–14 years: 1450ml**
• 15–18 years: 1800ml**

* excluding Na ** excluding Na, K & Cl

Water, maltodextrin, rehydrated chicken meat 6.9%, rehydrated vegetables 4.3 % (peas 3.8%, green beans 0.54%), vegetable oils (rapeseed, sunflower), milk proteins, peach puree (1.4%), orange juice from concentrate (1.2%), fibres (pea fibre, acacia gum, fructooligosaccharides, inulin), emulsifiers (E472c, E471), MCT oil, minerals (potassium phosphate, calcium chloride, calcium lactate, calcium phosphate, sodium chloride, potassium chloride, magnesium oxide, magnesium citrate, ferrous lactate, zinc sulphate, copper gluconate, manganese sulphate, sodium fluoride, potassium iodide, sodium molybdate, chromium chloride, sodium selenite), fish oil, choline bitartrate, vitamins (C, niacin, E, pantothenic acid, B6, riboflavin, thiamin, A, folic acid, K, biotin, D, B12), stabiliser (E407), taurine, L-carnitine, antioxidant (E304). Gluten Free. UHT sterilised. Packaged in a protective atmosphere.

The shelf life of Isosource® Junior Mix is 9 months from date of manufacture. Shake well before use. Unopened, store in a cool dry place. Once spiked use within 24 hours. Unused portion can be recapped, refrigerated and used within 24 hours. In order to maintain a constant flow, the use of a pump is recommended.

Isosource Junior Mix, 500ml, PIP code 414-3129, case size x 12.

Thornton-Wood, Saduera et al (2019)
To evaluate the acceptability (including gastrointestinal tolerance and compliance) of a Paediatric enteral formula with ingredients derived from real food for children over 12 months of age.

Aim: To evaluate tolerance of an enteral formula derived with real food ingredients administered to children via tube feeding.

Design: A prospective, observational study, N 19 children (aged 1-14 years) requiring tube feeding. Participants, under the supervision of a dietitian and multidisciplinary team, were changed to Isosource® Junior Mix for 7 days. Participants had a range of medical conditions; global developmental delay, epilepsy, cerebral palsy and Down’s syndrome

Outcome measures:Gastrointestinal tolerance (diarrhoea, constipation, bloating, distension, nausea, vomiting, flatulence, abdominal pain and prescribed formula versus taken were all recorded). Stool type was measured using the Bristol Stool Chart.

Results:

• 19 participants were enrolled into the study and 16 completed the study.
• Gastrointestinal symptoms: Positive changes in stool consistency; becoming firmer and decreasing in frequency. One child saw improved mood, eye contact and concentration. Resolution of reflux and gradual decrease in retching were observed in 2 participants. One child improved potty training
• Average intake of formula = 730mls (480–1400 ml)

Conclusion:

• The new tube feed formula made with real food ingredients was well tolerated by the majority of participants, with a decrease in gastrointestinal symptoms in some and beneficial changes in stool type in others.

Samela et al. (2016)
Transition to a Tube Feeding Formula With Real Food Ingredients in Pediatric Patients With Intestinal Failure. Nutrition in Clinical Practice. Nutrition in Clinical Practice. Volume 32 Number 2 April 2017 277– 281

Aim: To test the tolerance of a tube feeding formula with real food ingredients in pediatric patients with intestinal failure.

Design: Retrospective analysis of patient journals and the symptoms. Patients received continuous enteral nutrition or a combination of continuous and bolus feedings of Compleat® Paediatric.

10 children ( > 1y, Average age: 28.1 months) with congenital or acquired severe gastrointestinal disease on PN > 60 days

Outcome measures: Stool consistency and volume (number of stools in 24-hour period). Abdominal distention, gas production, vomiting and overall comfort level.

Results:

• 9/10 children tolerated the transition to tube feeding with derived from food ingredients
• Reduced diarrhoea and constipation
• Improvements in stool frequency
• All children stopped the use of supplemental fibre and stool softeners

Conclusion:

Tube feeding with ingredients from real food (Compleat® Pediatric) resulted in significant improvements in tolerance to tube feedings after PN support and improved stooling patterns.

Pentiuk et al. (2011)
Pureed by Gastrostomy Tube Diet Improves Gagging and Retching in Children With Fundoplication. JPEN, 2011; 35(3): 375-379

Aim: To test whether a pureed by gastrostomy tube diet can improve tolerance, gagging and retching symptoms in response to tube feeding after Nissen fundoplication.

Design: Retrospective review of patient journals and the symptoms N=33 children (average age 34.2 months) who had undergone Nissen fundoplication surgery in addition to G-tube placement. 88% of children had a developmental delay Patients who received commercially prepared baby food or formulas the base of the diet.

Outcome measures: Individualised feeding plan and fluid goals assessed after at least 2 months. Intake of multivitamin, calcium or electrolytes. Body weight development. Gagging and retching.

Results:

• 52% of children reported 76-100% reduction in gagging and retching
• 73% had ≥ 50% reduction in symptoms
• 57% had an increase in oral food intake (decrease in oral aversion)
• None of the children had worsening of symptoms and all children gained appropriate amount of weight
• Anecdotal reports of reduced constipation on pureed by gastrostomy tube diet

Conclusion:

• Blenderised tube feed formulas reduce symptoms of gagging and retching seen in children post-fundoplication surgery.
• Pureed by gastrostomy tube diets can reduce aversion to food often seen in this patient population.

BDA Policy Statement. The Use of Blended Diet with Enternal Feeding Tubes. November 2019

BDA policy statement 2019 - Offer blended diets where appropriate and allow parent choice.