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Faecal elastase 1 levels in premature and full term infants
M Kori1, A Maayan-Metzger, R Shamir
1Institute of Pediatric Gastroenterology and Nutrition, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Insights
Faecal elastase 1 (FE1) levels are low in newborn meconium and rise by day 3 in term infants. Preterm infants require longer to reach normal FE1 levels, influenced by gestational age.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Biochemistry
Background:
- Faecal elastase 1 (FE1) is a key indicator of pancreatic function.
- Limited data exists on FE1 ontogeny in infants.
- Understanding infant pancreatic enzyme development is crucial.
Purpose of the Study:
- To investigate FE1 levels in preterm and term neonates.
- To determine the influence of gestational and postconceptual age on FE1 levels.
- To establish reference ranges for infant pancreatic function testing.
Main Methods:
- Serial stool samples collected from 77 neonates (preterm and term).
- FE1 levels measured using a commercial ELISA kit.
- Correlation analysis between FE1 levels and gestational/postconceptual age.
Main Results:
- Meconium FE1 levels were universally below normal (<200 μg/g).
- FE1 levels significantly increased from sample 1 (45.9 μg/g) to sample 2 (243.0 μg/g) (p < 0.001).
- Lower gestational age correlated with a longer time to reach normal FE1 levels.
Conclusions:
- Meconium is unsuitable for assessing pancreatic sufficiency due to low FE1.
- Term newborns reach normal FE1 by day 3; preterm infants by 2 weeks (if <28 weeks gestation).
- Earlier enteral feeding and higher gestational age accelerate normalization of FE1 levels.
Background:
Determination of faecal elastase 1 (FE1) is a simple, relatively inexpensive, non-invasive, highly specific and sensitive test for determining pancreatic function. Secretion of pancreatic enzymes varies during infancy, but there are almost no specific data on the ontogeny of elastase 1 in human babies.
Aim:
To study FE1 levels in preterm and term babies, and to determine the possible effect of gestational and postconceptual age on these levels.
Methods:
Serial stool samples were collected and tested for FE1 level from 77 premature and full term infants. FE1 levels were determined by a commercially available enzyme linked immunosorbent assay (ELISA) kit.
Results:
A total of 232 stool samples were collected from 77 neonates. The FE1 level measured in the first stool sample (meconium) was below normal (200 micro g/g stool) in all samples regardless of gestational age. Sixty three neonates had at least two samples tested for FE1 level. The mean (SD) level of FE1 in sample 1 was 45.9 (51.1) micro g/g stool and was significantly (p < 0.001) lower than in sample 2 (243.0 (164.9) micro g/g stool). The lower the gestational age of the newborn, the more time it took for FE1 to reach normal levels.
Conclusions:
FE1 levels in meconium are low, and studies in meconium should be avoided if pancreatic sufficiency is to be determined. FE1 reaches normal levels by day 3 in term newborns and by 2 weeks in infants born before 28 weeks gestation. Normal levels are reached sooner in infants of more advanced gestational age who start enteral feeding earlier.
