Elsevier

The Journal of Pediatrics

Volume 133, Issue 5, November 1998, Pages 645-649
The Journal of Pediatrics

Early feeding, feeding tolerance, and lactase activity in preterm infants,☆☆,,★★

https://doi.org/10.1016/S0022-3476(98)70105-2Get rights and content

Abstract

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. (J Pediatr 1998;133:645-9)

Section snippets

Study Design

Infants in the study were part of a prospective feeding trial.12 They were enrolled within 96 hours of birth, stratified by gestational age (26 to 27 vs 28 to 30 weeks) and by diet (mothers’ own milk vs preterm formula), and assigned randomly among 4 treatment combinations in a balanced 2-way design where the 2 factors were the time of initiation of feeding (early, 4 days of age vs standard, 15 days of age) and the method of tube feeding (continuous infusion vs bolus). The 4 treatment

Results

Although the data at 28 days (Table I) taken in isolation suggest a difference between the early continuous and the early bolus groups, it should be borne in mind that the actual analysis took into account the repeated measures nature of the study (ie, the change over time; see Data Analyses).

. Lactase activity (urine to milk lactulose/lactose ratio)

Age (d)Group
Early continuousEarly bolusStandard continuousStandard bolus
102.8 ± 3.5*3.4 ± 3.81.4 ± 1.11.3 ± 0.8
288.0 ± 5.412.1 ± 7.76.5 ± 4.37.3 ±

Discussion

Early enteral feeding had a marked effect on the development of lactase activity. Lactase activity rose at a faster rate in the early group than in the standard group. At 10 days of age lactase activity was >100% greater than that measured in the standard group and at 28 days of age was still 60% greater. These results cannot be explained by differences in clinical characteristics of the infants or the infants’ nutritional history, because these were comparable between groups. Our data also

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From USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Department of Pathology, Baylor College of Medicine; Texas Children’s Hospital, Houston, Texas, and Department of Biobehavioral Nursing, University of Washington, Seattle, Washington.

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Supported by the National Institute of Child Health and Human Development, grant No. RO-1-HD-28140, the American Gastroenterological Association, Smith-Kline Beecham Clinical Research Award, the General Clinical Research Center MO1 RR-00188, and the USDA/ARS under Cooperative Agreement No. 58-6250-1-003. This work is a publication of the USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas. The contents of this publication do not necessarily reflect the views or policies of the USDA, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Reprint requests: Robert J Shulman, MD, 1100 Bates St, Houston, TX 77030.

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0022-3476/98/$5.00 + 0  9/21/93856

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