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Intestinal permeability in relation to birth weight and gestational and postnatal age
R M van Elburg1, W P F Fetter, C M Bunkers
1Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands. rm.vanelburg@vumc.nl
Insights
Intestinal permeability in preterm infants is not linked to gestational age or birth weight. However, it decreases significantly within the first week of life, indicating rapid postnatal adaptation.
Area of Science:
- Neonatal physiology
- Gastrointestinal development
- Perinatal medicine
Background:
- Intestinal permeability is a crucial indicator of gastrointestinal health.
- Understanding changes in intestinal permeability in neonates is vital for assessing gut function and development.
- Preterm infants may have altered intestinal barrier function compared to term infants.
Purpose of the Study:
- To investigate the relationship between intestinal permeability and key neonatal factors including birth weight, gestational age, postnatal age, and perinatal risks.
- To compare intestinal permeability in preterm and healthy term infants.
Main Methods:
- Intestinal permeability was assessed using the sugar absorption test, measuring the urinary lactulose/mannitol ratio.
- The test was administered within two days of birth and again three to six days later.
- Participants included preterm infants (26-36 weeks gestation) and healthy term infants.
Main Results:
- In preterm infants, intestinal permeability (lactulose/mannitol ratio) did not correlate with gestational age or birth weight.
- Intestinal permeability was significantly higher within the first two days of life compared to three to six days later (p<0.001).
- Preterm infants exhibited higher intestinal permeability than term infants only within the first two days of life (p < 0.001).
Conclusions:
- Intestinal permeability in preterm infants is not dependent on gestational age or birth weight.
- A notable decrease in intestinal permeability occurs within the first week of postnatal life in preterm infants.
- These findings suggest a rapid postnatal adaptation of the small intestine in preterm neonates.
Objective:
To determine the relation between intestinal permeability and birth weight, gestational age, postnatal age, and perinatal risk factors in neonates.
Study Design:
Intestinal permeability was measured by the sugar absorption test within two days of birth and three to six days later in preterm and healthy term infants. In the sugar absorption test, the urinary lactulose/mannitol ratio is measured after oral ingestion of a solution (375 mosm) of lactulose and mannitol.
Results:
A first sugar absorption test was performed in 116 preterm (26-36 weeks gestation) and 16 term infants. A second test was performed in 102 preterm and nine term infants. In the preterm infants, the lactulose/mannitol ratio was not related to gestational age (r = -0.09, p = 0.32) or birth weight (r = 0.07, p = 0.43). The median lactulose/mannitol ratio was higher if measured less than two days after birth than when measured three to six days later (0.427 and 0.182 respectively, p<0.001). The lactulose/mannitol ratio was higher in preterm infants than term infants if measured within the first 2 days of life (0.404 and 0.170 respectively, p < 0.001), but not different three to six days later (0.182 and 0.123 respectively, p = 0.08). In multiple regression analysis of perinatal risk factors, only umbilical arterial pH correlated with the lactulose/mannitol ratio in preterm infants less than 2 days of age (T = -1.98, p = 0.05).
Conclusions:
In preterm infants (26-36 weeks gestation), intestinal permeability is not related to gestational age or birth weight but is higher during the first 2 days of life than three to six days later. It is higher in preterm infants than in healthy term infants only if measured within two days of birth. This suggests rapid postnatal adaptation of the small intestine in preterm infants.