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Limited fat digestion in infants with bronchopulmonary dysplasia
1Center for Infant Nutrition to Prevent Illnesses in Adult Life, Maternity Hospital Macedonio Melloni, Milan, Italy.
Insights
Infants who develop bronchopulmonary dysplasia show reduced lipase activity and bile acid concentrations, leading to impaired fat absorption and poor weight gain. This study highlights digestive enzyme deficiencies in bronchopulmonary dysplasia development.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Pediatric Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in premature infants, often associated with respiratory distress and long-term pulmonary issues.
- Digestive system immaturity and dysfunction can contribute to poor nutritional outcomes in very-low-birthweight infants.
Purpose of the Study:
- To investigate digestive enzyme activity (lipase, trypsin) and bile acid concentrations in infants with and without BPD.
- To correlate these digestive parameters with fat absorption, nitrogen balance, and growth rates in infants developing BPD.
Main Methods:
- Duodenal juice analysis for lipase and trypsin activity and bile acid concentrations in three infant groups: BPD, no-BPD, and healthy controls.
- Assessment of fat and nitrogen balance during the 5th and 6th postnatal weeks.
- Measurement of serum urea and daily weight gain.
Main Results:
- Infants with BPD exhibited significantly lower duodenal lipase activity and bile acid concentrations below the critical micellar concentration.
- Fecal fat excretion was significantly higher in the BPD group compared to controls and infants without BPD.
- The BPD group showed the lowest weight gain and higher serum urea levels.
Conclusions:
- Development of bronchopulmonary dysplasia is associated with impaired fat digestion and absorption, potentially due to reduced lipase activity and bile acid availability.
- These digestive abnormalities may contribute to the inadequate weight gain observed in infants with BPD.
- Further research into nutritional support and digestive aids for BPD infants is warranted.
Abstract:
In 10 hyaline membrane disease patients with development of bronchopulmonary dysplasia, 16 hyaline membrane disease patients without development of bronchopulmonary dysplasia, and 12 very-low-birthweight infants without major medical problems, we measured the lipase and trypsin activity as well as the bile acids concentrations in preprandially aspirated duodenal juice. In addition, fat and nitrogen balances were performed during the 5th and 6th weeks of postnatal life. The mean duodenal lipase activity in the patients with bronchopulmonary dysplasia was significantly lower than those of the patients without bronchopulmonary dysplasia (4.41 +/- 3.0 versus 9.95 +/- 3.0 U/ml, p < 0.05) and of the controls (19.94 +/- 6.8 U/ml). The mean total bile acid concentration was below the critical micellar concentration of 4 mmol/L only in the patients with bronchopulmonary dysplasia. The fecal fat excretion rate in the patients with bronchopulmonary dysplasia was significantly higher than in the patients without bronchopulmonary dysplasia (21.4 +/- 4.6% versus 11.3 +/- 3.4% of intake, p < 0.01) as well as that of the controls (7.9 +/- 2.8% of intake). The serum urea concentrations were similar in the patients without bronchopulmonary dysplasia and in the controls (1.97 +/- 0.6 and 1.89 +/- 0.4 mmol/L, respectively) but significantly higher in the patients with bronchopulmonary dysplasia (2.54 +/- 0.5 mmol/L). The lowest weight gain was found in the patients with bronchopulmonary dysplasia (8.2 +/- 4.7 g/kg/day). It was significantly lower than one of the patients without bronchopulmonary dysplasia or the controls (13.5 +/- 4.0 and 16.2 +/- 3.7 g/kg/day, respectively). The data indicate that patients who develop bronchopulmonary dysplasia have a limited fat absorption, which may help to explain the inadequate weight gain.