Digestive enzyme replacement in very preterm infants: a prospective observational study

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Nutritional Science

Background:

• Very preterm infants often exhibit poor postnatal growth despite adequate enteral nutrition.
• This growth deficit is frequently associated with transient exocrine pancreatic insufficiency, evidenced by low fecal pancreatic elastase-1 (FPE-1) concentrations.
• Exogenous digestive enzyme supplementation is being explored as a potential therapeutic strategy.

Purpose of the Study:

• To evaluate the efficacy of exogenous digestive enzyme replacement in improving growth velocity in very preterm infants with low FPE-1 concentrations.
• To assess the impact of enzyme therapy on daily weight gain, and weight gain relative to protein and caloric intake.

Main Methods:

• A bicentric prospective observational study was conducted on very preterm infants (<32 weeks gestational age, <1500g birth weight) with low FPE-1 (<200 µg/g).
• Infants received a specific dosage of lipase and protease enzymes with each feeding, with dosage adjustments based on body weight.
• Growth velocity was compared during the 14 days before and the 14 days after enzyme initiation.

Main Results:

• Seventy-one infants were included, with a median birth weight of 700g and gestational age of 25.4 weeks.
• Daily weight gain significantly increased from 14.7 to 19.5 g/kg/d post-intervention (p < 0.001).
• Relative weight gain per kg protein and per kcal fed also showed significant improvements (p < 0.001). Enzyme efficacy was more pronounced with pasteurized milk compared to raw milk.

Conclusions:

• Exogenous digestive enzyme administration is associated with enhanced weight gain in very preterm infants experiencing transient exocrine pancreatic insufficiency.
• This therapeutic approach demonstrates potential for optimizing growth outcomes in this vulnerable population.
• The type of milk feeding (pasteurized vs. raw) may influence the effectiveness of enzyme replacement therapy.