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Sugar absorption in healthy preterm and full-term infants
Insights
Newborns frequently experience incomplete carbohydrate absorption, but this capacity improves within the first month, especially in preterm infants. Breath hydrogen tests indicate developing intestinal function for carbohydrate digestion.
Area of Science:
- Neonatal physiology
- Gastroenterology
- Pediatric nutrition
Background:
- Carbohydrate absorption is crucial for infant nutrition.
- Maturation of the neonatal gastrointestinal tract influences nutrient assimilation.
- Understanding carbohydrate malabsorption in neonates is essential for optimizing feeding strategies.
Purpose of the Study:
- To investigate carbohydrate absorption in term and preterm neonates.
- To evaluate the efficacy of different methods for assessing carbohydrate malabsorption.
- To determine the timeline for the development of carbohydrate hydrolyzing capacity in the neonatal period.
Main Methods:
- Respiratory hydrogen (H2) measurements (24-h and 4-h tests).
- Fecal pH analysis.
- Chromatographic analysis of stool for sugar content.
Main Results:
- High incidence of incomplete carbohydrate absorption observed in both term and preterm infants.
- 24-hour H2 collection test was more effective than the 4-hour test.
- Negative breath H2 excretion correlated with the development of intestinal carbohydrate hydrolysis capacity.
- Functional lactase developed within the first month in most preterm infants with malabsorption.
Conclusions:
- Incomplete carbohydrate absorption is common in newborns but typically resolves within the first month.
- Breath H2 excretion is a reliable indicator of developing intestinal digestive function.
- Human milk growth modulators may accelerate small intestinal maturation and improve carbohydrate absorption.
Abstract:
We have studied carbohydrate absorption in 40 healthy term infants and 10 preterm neonates (31-35 weeks gestation) by respiratory H2, fecal pH, and chromatographic analysis of stools. Sequential studies of H2 excretion (24-h collection) in response to breast feeding were carried out in premature infants during the first 8 weeks of life. Five expired H2 during the first 2 weeks, and two continued to do so in the 3rd to 4th weeks. Breath H2 excretion fell below 10 ppm by 8 weeks and was not related to feeding or sleep. In term neonates, the frequency of incomplete carbohydrate absorption (4-h test) at the end of the first week was 36% for 14 breast-fed, 42% for 12 formula-fed, and 64% for 14 mixed-fed neonates (not significant differences). There were no significant differences between the absorbing and malabsorbing subjects in fecal pH. Chromatographic analysis showed only small quantities of sugars. In summary, incomplete carbohydrate absorption occurred in a high percentage of the newborns studied; the 24-h test evaluated better than the 4-h test; and negative breath H2 excretion indicated development of the capacity of the small intestine to hydrolyze carbohydrates. In the majority of the preterm malabsorbing babies, completely functional lactase occurs within the first month of life. The growth modulators in human milk may increase the rate of maturing of the small intestine.