Retrospective cohort analysis on pancreatic enzyme substitution in very low birthweight infants with postnatal growth failure

Arch Dis Child Fetal Neonatal Ed. 2018 Sep;103(5):F485-F489. doi: 10.1136/archdischild-2017-313278. Epub 2017 Nov 9.

Abstract

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.

Keywords: growth; neonatology; nutrition.

MeSH terms

  • Body Weight Maintenance / physiology
  • Case-Control Studies
  • Cohort Studies
  • Enteral Nutrition / methods
  • Enzyme Replacement Therapy / methods*
  • Female
  • Germany
  • Growth Disorders / diagnosis
  • Growth Disorders / physiopathology
  • Growth Disorders / therapy
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature / growth & development
  • Infant, Very Low Birth Weight / growth & development
  • Male
  • Nutritional Support / methods
  • Pancreatic Extracts / therapeutic use*
  • Treatment Outcome
  • Weight Gain / physiology

Substances

  • Pancreatic Extracts