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Early feeding, feeding tolerance, and lactase activity in preterm infants
R J Shulman1, R J Schanler, C Lau
1USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Insights
Early enteral feeding in preterm infants significantly boosts intestinal lactase activity. This enhanced lactase activity is linked to improved clinical outcomes and intestinal maturity.
Area of Science:
- Neonatal nutrition
- Gastrointestinal physiology
- Pediatric gastroenterology
Background:
- Intestinal lactase activity is crucial for lactose digestion in infants.
- The optimal timing for initiating enteral feeding in preterm infants remains a key clinical question.
- Understanding factors influencing lactase development is vital for improving infant gut health.
Purpose of the Study:
- To investigate if early enteral feeding initiation impacts intestinal lactase activity development in preterm infants.
- To explore the clinical significance and potential ramifications of varying lactase activity levels.
- To compare lactase activity between milk-fed and formula-fed preterm infants.
Main Methods:
- Randomized controlled trial involving 135 preterm infants (26-30 weeks gestation).
- Two feeding groups: early (4 days) and standard (15 days) enteral feeding initiation.
- Lactase activity assessed via urinary lactulose/lactose ratio at 10, 28, and 50 days of age.
Main Results:
- Lactase activity increased significantly over time in all infants.
- Early feeding group demonstrated 100% higher lactase activity at 10 days and 60% higher at 28 days.
- Higher lactase activity correlated with shorter time to full enteral feeding and fewer abdominal X-rays.
Conclusions:
- Early enteral feeding accelerates intestinal lactase activity development in preterm neonates.
- Lactase activity serves as a biomarker for intestinal maturity and may predict clinical outcomes.
- Further research is needed to clarify the role of milk composition versus lactose concentration on lactase activity.
Objective:
We sought to ascertain whether the timing of feeding initiation affected the development of intestinal lactase activity and whether there are clinical ramifications of lower lactase activity.
Study Design:
Preterm infants (26 to 30 weeks' gestation; n = 135) were randomly assigned to begin enteral feedings at either 4 (early group) or 15 days of age (standard group). At 10, 28, and 50 days of age lactase activity was determined by measuring the urinary ratio of lactulose/lactose after the 2 sugars were administered.
Results:
Lactase activity increased significantly over time. Infants in the early group had greater lactase activity at 10 days of age (by 100%) and 28 days of age (by 60%) than the standard group. At 10 days of age lactase activity was greater in milk- versus formula-fed infants. The time required to achieve full enteral feedings, the number of abnormal abdominal x-ray examinations, and the total number of abdominal x-ray examinations were inversely related to lactase activity.
Conclusions:
Early feeding increases intestinal lactase activity in preterm infants. Lactase activity is a marker of intestinal maturity and may influence clinical outcomes. Whether the effects of milk on lactase activity were due to the greater concentration of lactose in human milk compared with that in formula must be determined.