Protracted Maturation of Pancreatic-Specific Elastase 1 Excretion in Preterm Infants of Extremely Low Gestational Age

Münch, Annette; Garten, Lars; Bührer, Christoph

Journal of Pediatric Gastroenterology & Nutrition: May 2013 - Volume 56 - Issue 5 - p 532–536
doi: 10.1097/MPG.0b013e31827fb091
Original Articles: Hepatology and Nutrition

Objectives: The aim of the present study was to better understand the exocrine pancreatic function of extremely preterm infants.

Methods: Pancreatic-specific elastase 1 (PSE1) activity was determined in spot stool samples of 69 preterm infants of gestational age <32 weeks and birth weight <1250 g. Assays were conducted on samples collected at 2 (N = 56), 4 (N = 46), and 6 weeks of age (N = 23).

Results: PSE1 activity increased from week 2 (median [interquartile range] 84 [48–187] μg/g) to week 4 (164 [87–251 μg/g; P < 0.001) but not thereafter (169 [82–298] μg/g at week 6). The maturational increase in PSE1 activity was observed only in infants of gestational age <28 weeks (P < 0.001). At 2 weeks after birth, PSE1 levels were lower in infants of gestational age <28 weeks than in infants of gestational age ≥28 weeks (77 [43–110] vs 165 [56–300] μg/g; P = 0.019), but this difference was less pronounced at 4 weeks (153 [77–226] vs 230 [108–503] μg/g; P = 0.070) and had disappeared by 6 weeks (163 [76–258] vs 175 [85–418] μg/g; P = 0.576). In infants on full enteral feeding regimens 4 weeks after birth, PSE1 levels were associated with weight gain per unit of energy intake (Rs = 0.431; P = 0.005). This measure of weight gain was lower (P = 0.040) in infants with PSE1 levels <200 μg/g (0.110 [0.081–0.139] g/kcal, N = 25) than in those with PSE1 levels ≥200 μg/g (0.139 [0.117–0.157] g/kcal, N = 15). Administration of pancreatic enzymes to infants showing PSE1 excretion levels <200 μg/g did not enhance weight gain.

Conclusions: Extremely preterm infants have limited exocrine pancreatic function during the first weeks of life, which may contribute to growth failure.

Department of Neonatology, Charité University Medical Center, Berlin, Germany.

Address correspondence and reprint requests to Dr Annette Münch, Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany (e-mail: annette.muench@charite.de).

Received 29 February, 2012

Accepted 25 November, 2012

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,