Early lactase enzyme supplementation: Efficacy to promote growth and feeding tolerance in preterm infants: A randomized controlled trial

Transient lactase deficiency is common in preterm infants, which may contribute to feeding intolerance, poor growth, and adverse clinical outcomes. Early lactase enzyme supplementation can improve the clinical manifestations produced by lactose intolerance in preterm infants with better weight gain and rapid feeding increment.

To evaluate the efficacy and safety of lactase enzyme supplementation for improving feeding tolerance and promoting growth without adverse outcomes in Egyptian preterm infants.

This prospective, randomized, double-blind, controlled trial included a total of 109 preterm infants born before 34 weeks' gestation; 55 received lactase supplementation and 54 served as controls. Clinical signs of feeding intolerance, growth parameters, stool reducing substances, stool pH, laboratory findings, and other parameters such as hospital stay duration and patient outcome were assessed over 2 weeks.

The intervention group had lower gastric residuals at week 1 (P = 0.0002) and week 2 (P = 0.003), lower abdominal distension at week 1 (P = 0.007) and week 2 (P < 0.001), fewer emesis attacks at week 1 (P = 0.001), and a lower incidence of diarrhea at week 1 (P = 0.004) and week 2 (P = 0.002). Negative stool reducing substances were more frequent in the intervention group at week 1 (P = 0.011) and week 2 (P < 0.001), with significant in-group improvement only in the intervention arm (P < 0.001). Stool pH was higher in the intervention group at week 1 (P < 0.0001) and week 2 (P < 0.0001). Weight gain was greater (P < 0.0001), while necrotizing enterocolitis (NEC) was less frequently reported in the intervention group (P = 0.0448).

Lactase supplementation can improve feeding tolerance symptoms, stool pH, and daily weight gain, and may contribute to a reduction in NEC incidence in preterm infants.