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Fecal Elastase in Preterm Infants to Predict Growth Outcomes.

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Fecal elastase (ELA1) levels increase in preterm infants fed human milk, but early pancreatic insufficiency (PI) does not predict growth. Further research is needed to explore ELA1 as a biomarker for growth failure.

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Area of Science:

  • Neonatology
  • Pediatric Gastroenterology
  • Nutritional Science

Background:

  • Preterm infants often exhibit functional pancreatic insufficiency, impacting nutrient absorption and growth.
  • Developmental pancreatic insufficiency (PI) is characterized by reduced production of pancreatic enzymes like lipase and proteases.
  • This condition may contribute to growth failure in vulnerable preterm populations.

Purpose of the Study:

  • To longitudinally assess fecal elastase (ELA1) levels in preterm infants.
  • To determine if early ELA1 levels are associated with growth outcomes in this cohort.
  • To investigate the relationship between pancreatic function and growth in preterm infants fed an exclusive human milk diet.

Main Methods:

  • A prospective observational study involving 30 preterm infants (24-34 weeks gestational age, birth weight ≤1250 g).
  • Infants were fed an exclusive human milk diet, including human milk-based fortifier.
  • Fecal ELA1 was quantified using ELISA at two time points: early (7.5 ± 1.8 DOL) and late (63.6 ± 24.1 DOL).

Main Results:

  • Fecal ELA1 levels significantly increased from early to late measurements (192.2 ± 96.4 µg/g to 268.0 ± 80.3 µg/g, P = 0.01).
  • Infants with early PI (ELA1 < 200 µg/g) were more likely male and had lower birth measurements (gestational age, weight, length, head circumference).
  • Birth characteristics, not early PI status, independently predicted somatic growth.

Conclusions:

  • Fecal ELA1 levels increase with postnatal age in preterm infants on an exclusive human milk diet.
  • While pancreatic function may contribute to early growth failure, ELA1's predictive role requires further investigation.
  • Larger cohort studies are necessary to validate fecal ELA1 as a biomarker for growth failure in preterm infants.