In vivo lactose digestion in preterm infants

In vitro studies of intestinal lactase activity and breath-hydrogen studies have suggested that the capacity for lactose digestion in preterm infants is less than the usual intake. To explore this question using an in vivo approach, we determined the fraction of dietary lactose hydrolyzed to glucose (and galactose) in 14 preterm infants with a gestational age of 26-31 wk at the time of birth but a postconceptional age of 31-37 wk at the time of study. The percentage of lactose digested was estimated after 6-h, primed, constant gastric infusions of [1-(13)C]glucose and D-[-1-(13)C]lactose on alternate days. A coefficient of lactose fermentation was derived from the rates of pulmonary excretion of hydrogen and carbon dioxide. Mean (+/- SD) lactose digestion was 79 +/- 26%. There was a significant inverse rank (r = -0.799, P < 0.01) and linear (r = -0.587, P < 0.05) correlation between this variable and postconceptional age. The percentage of lactose fermented averaged 35 +/- 27%.