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rhBSSL Improves Growth and LCPUFA Absorption in Preterm Infants Fed Formula or Pasteurized Breast Milk

Casper, Charlotte*; Carnielli, Virgilio P.; Hascoet, Jean-Michel; Lapillonne, Alexandre§; Maggio, Luca||; Timdahl, Kristina; Olsson, Birgitta; Vågerö, Mårten; Hernell, Olle#

Journal of Pediatric Gastroenterology & Nutrition: July 2014 - Volume 59 - Issue 1 - p 61–69
doi: 10.1097/MPG.0000000000000365
Original Articles: Hepatology and Nutrition

Objectives: Preterm infants often experience suboptimal growth, which can affect organ development. The aim of this study was to improve growth by treatment with bile salt–stimulated lipase (BSSL), naturally present in breast milk, but lost after pasteurization, and absent in formula.

Methods: Two clinical trials were performed with a predefined analysis of combined data to investigate the effects of recombinant human BSSL (rhBSSL) treatment on growth velocity and fat absorption in preterm infants. The studies were randomized and double-blinded comparing 7-day treatment with rhBSSL and placebo, administered in pasteurized breast milk or formula, using a crossover design.

Results: Sixty-three infants were evaluated for safety. At randomization, the mean (standard deviation) weight was 1467 (193) g and mean postmenstrual age was 32.6 (0.5) weeks. Sixty and 46 infants were evaluated for growth velocity and fat absorption, respectively. rhBSSL treatment significantly improved mean growth velocity by 2.93 g · kg−1 · day−1 (P < 0.001) compared with placebo (mean 16.86 vs 13.93 g · kg−1 · day−1) and significantly decreased the risk of suboptimal growth (<15 g · kg−1 · day−1) (30% vs 52%, P = 0.004). rhBSSL significantly increased absorption of the long-chain polyunsaturated fatty acids, docosahexaenoic acid, and arachidonic acid by 5.76% (P = 0.013) and 8.55% (P = 0.001), respectively, but had no significant effect on total fat absorption. The adverse-event profile was similar to placebo.

Conclusions: In preterm infants fed pasteurized breast milk or formula, 1 week of treatment with rhBSSL was well tolerated and significantly improved growth and long-chain polyunsaturated fatty acid absorption compared to placebo. This publication presents the first data regarding the use of rhBSSL in preterms and the results have led to further clinical studies.

*Unit of Neonatology, Children's Hospital, Paul Sabatier University Toulouse, Toulouse, France

Division of Neonatology, Polytechnic University of Marche and Salesi's Children Hospital, Ancona, Italy

Department of Neonatology, Maternite Regionale, Université de Lorraine, Nancy

§Department of Neonatology, Assistance Publique Hôpitaux de Paris Necker Hospital, Paris Descartes University, Paris, France

||Division of Neonatology, Department of Pediatrics, Catholic University Sacred Heart, Rome, Italy

Swedish Orphan Biovitrum (Sobi), Stockholm

#Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.

Address correspondence and reprint requests to Kristina Timdahl, Medical Director, Swedish Orphan Biovitrum (Sobi), SE-112 76 Stockholm, Sweden (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site ( registration no: NCT00658905 and NCT00659243.

The preterm formula study was carried out partially with research funding from the European Community's Sixth Framework Program (the Early Nutrition Programming [EARNEST]) using a formula provided by Ordesa. Swedish Orphan Biovitrum (Sobi) provided the remainder of the funding for the 2 phase II studies and their analysis. O.H., A.L., C.C., V.P.C. are consultants to Sobi for the rhBSSL project. K.T., B.O., and M.V. are employed by Sobi and holders of company shares. The other authors report no conflicts of interest.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially.

Received October 16, 2013

Accepted February 28, 2014

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,