Objective To evaluate the effects of pancreatic enzyme substitution (PES) in selected very low birthweight (VLBW) infants with poor postnatal growth despite intensified nutritional support.

Design Retrospective historic cohort study with matched controls.

Setting Single level III neonatal intensive care unit.

Patients Infants with a gestational age at birth <32 weeks and birth weight <1500 g born between 1 January 2005 and 31 December 2014 (n=26) who received PES for restricted postnatal growth despite intensified enteral nutritional support in comparison with infants matched for birth weight, birth year, gestational and postnatal age (n=52).

Interventions PES 15–93 mg/g fat with enteral feeds.

Main outcome measures The difference in SD score (SDS) differences for weight during the 7 days before and after onset of PES and weight gain in g/kg/d. Data are presented as median (P10–P90).

Results Gestational age was 26.6 (24.4–29.9) weeks in enzyme substituted versus 26.4 (24.7–29.9) weeks in matched controls, and birth weight was 648(420–950)g versus 685(453–949)g. SDS differences for weight improved after onset of PES by 0.18(−0.12 to 0.53) in PES infants versus −0.04(−0.31 to 0.44) in controls. Weight gain increased in the PES group from 13.6 (4.2–22.9) g/kg/day in the week before to 19.0 (10.9–29.1) g/kg/day in the week after the onset of PES. There was no difference in weight gain in substituted subgroups receiving formula/pasteurised human milk versus unpasteurised human breast milk or who had pancreatic-specific elastase-1 concentrations in stool >200 µg/g versus≤200 µg/g. No adverse effects were noted.

Conclusions PES in selected VLBW infants with growth failure despite intensified enteral nutritional support was associated with a significant increase in weight gain in the first 7 days of PES.k