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Pancreatic Insufficiency, Digestive Enzyme Supplementation, and Postnatal Growth in Preterm Babies
Allan Jenkinson1, Narendra Aladangady1,2, Sven Wellmann3
1Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, UK.
Insights
Optimizing growth in preterm infants is crucial for neurodevelopment. While digestive enzyme supplementation may aid growth, current evidence does not support its routine use in preterm babies due to pancreatic insufficiency.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Developmental Biology
Background:
- Postnatal growth is critical for long-term neurodevelopmental outcomes in neonates.
- Preterm infants often experience feeding intolerance due to digestive immaturity and pancreatic insufficiency.
- This can lead to postnatal growth failure, impacting overall infant health.
Purpose of the Study:
- To review exocrine pancreatic enzyme deficiencies in preterm infants.
- To explore methods for measuring exocrine pancreatic function.
- To assess the potential of enzyme replacement therapy for improving growth in preterm infants.
Main Methods:
- Literature review focusing on exocrine pancreatic function in preterm infants.
- Analysis of methods for assessing pancreatic exocrine function, including stool elastase.
- Evaluation of evidence regarding digestive enzyme supplementation for growth enhancement.
Main Results:
- Pancreatic exocrine function is immature in extremely preterm infants, potentially causing growth failure.
- Stool elastase is a viable non-invasive method for assessing pancreatic function in this population.
- Current evidence does not support the routine use of digestive enzyme supplementation for preterm infants.
Conclusions:
- Developmental immaturity of pancreatic exocrine function is a concern in extremely preterm infants.
- Non-invasive assessment of pancreatic function is feasible.
- Routine digestive enzyme supplementation is not currently recommended for preterm infants based on available evidence.
Background:
Optimising postnatal growth facilitates better long-term neonatal neurodevelopmental outcomes. Early postnatal growth is often hindered by a variety of factors unique to the extrauterine environment and digestive immaturity both contributing to reduced enteral feed tolerance during the first few days and weeks after birth. Preterm infants display varying levels of pancreatic insufficiency that are related to gestational age and providing digestive enzyme supplementation, may be one way in which to improve postnatal growth in enterally fed preterm babies.
Summary:
In this review, we explore which exocrine pancreatic enzymes are deficient in preterm babies, the methods by which exocrine pancreatic function is measured, potential avenues by which digestive enzyme replacement might improve postnatal growth failure, and which babies might benefit most from this intervention.
Key Messages:
Pancreatic exocrine function exhibits developmental immaturity in extremely preterm infants and may contribute to postnatal growth failure. Stool elastase is a simple, non-invasive method of assessing pancreatic function in preterm infants. Available evidence does not currently support routine use of digestive enzyme supplementation in preterm infants.
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