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Digestive enzyme replacement in very preterm infants: a prospective observational study
Sina Keidel1, Sven Wellmann2, Holger Michel2
1Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany. sina.keidel@charite.de.
Insights
Exogenous digestive enzyme replacement significantly improved weight gain in very preterm infants suffering from temporary exocrine pancreatic insufficiency. This intervention offers a promising approach to enhance growth in vulnerable neonates.
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.
Objectives:
Very preterm infants may display poor postnatal growth despite receiving recommended enteral intakes. This has been linked to transient exocrine pancreatic insufficiency, indicated by low fecal pancreatic elastase-1 (FPE-1) concentrations. We aimed to determine whether growth velocity may be improved by exogenous digestive enzyme replacement.
Methods:
In this bicentric prospective observational study, changes in growth velocity were assessed in very preterm infants (<32 weeks gestational age, <1500 g birth weight) with low FPE-1 concentrations (<200 µg/g). Infants received 350 U lipase from Rhizopus oryzae and 5.4 U protease from Aspergillus oryzae with every meal via gavage; the dosage was doubled once infants reached 1000 g. Average daily weight gain relative to body weight was compared during the 14 days preceding initiation of digestive enzyme replacement and during the first 14 days thereafter.
Results:
In 71 infants (median [interquartile range] birth weight 700 [570-980] g, gestational age 25.4 [24.4-28.4] weeks) born between March 1, 2022, and December 31, 2023, daily weight gain increased from 14.7 [7.3-19.7] to 19.5 [15.7-24.0] g/kg/d (p < 0.001), relative daily weight gain per kg protein fed from 4.0 [2.0-5.9] to 5.4 [4.4-6.5] g/kg (p < 0.001), and relative daily weight gain per kcal fed from 0.11 [0.06-0.16] to 0.15 [0.13-0.19] g/kcal/d (p < 0.001). Effects were non-significant in infants fed raw milk but marked in those who received pasteurized mother's own milk or donor milk.
Conclusion:
Administration of exogenous digestive enzymes was associated with increased weight gain in very preterm infants with transient exocrine pancreatic insufficiency.
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