• Features of the exocrine pancreatic function and lactose intolerance in premature babies

Features of the exocrine pancreatic function and lactose intolerance in premature babies

SOVREMENNAYA PEDIATRIYA.2018.8(96):42-49; doi 10.15574/SP.2018.96.42

Khasanova S. S., Kamilova A. Т.
Republican Perinatal Center, Ministry of Health of the Republic of Uzbekistan, Tashkent
Republican Specialized Scientific and Practical Medical Center of Pediatrics, Ministry of Health of the Republic of Uzbekistan, Tashkent

In the literature there are few data on the levels of fecal elastase in premature and full-term newborns, and data on the frequency of lactase deficiency (LD) in newborns with different gestational age are contradictory.

The aim of our study was to determine the activity of pancreatic elastase and lactase in premature babies up to 32 weeks. The study included 54 children born in the period from 22 to 32 weeks of gestation and 8 healthy full-term babies (control group).

Materials and methods. All children on the 13–14th day of life, in addition to the standard examination, were determined by the analysis of feces for the presence of carbohydrates by the Benedict method and determination the level of fecal elastase (FE) using enzyme immunoassay.

Results. By the 14th day of life in children with gestational age from 22 to 27 weeks, mild pancreatic insufficiency was established, the average PE in this group was 166.6±64.6 mg/g and they were significantly different compared to the full-term infants who amounted to 326.0±26.0 mg/g (p<0.050), whereas in the group of children with gestational age at birth from 28 to 32 weeks by the end of the second week of life, the values of pancreatic elastase were significantly higher and amounted to 278.6±10,3 mg/g (p>0.050), although they were lower than the full-term data, but the difference was not reliable (t=1.72). The results of the Benedict test showed an increase in the level of limit values in 25 (46.3%) children examined.

Conclusion. The data obtained allow us to conclude that mild pancreatic insufficiency was established in premature infants with a gestational age of 22–27 weeks to two weeks of age. Lactase deficiency was recorded in 46.3% of premature babies up to 32 weeks, the clinical manifestations of the disease were not specific and were characterized by stool liquefaction.

Key words: premature babies, fecal elastase, lactose insufficiency.

REFERENCES

1. Belyaeva IA, Bombardirova EP, Tarzyan EO. (2012). Disfunkcii pishchevareniya u nedonoshennyh detej Voprosy sovremennoj pediatrii. 11 (6):75–79.

2. Belyaeva IA, Turti TV, Mitish MD, Zimina EP, Rtishcheva MS, Tarzyan EO. (2014). Profilakticheskie aspekty vskarmlivaniya nedonoshennyh detej grudnym molokom. Pediatricheskaya farmakologiya. 11; 2: 13–18.

3. Diagnostika i kompleksnaya reabilitatsiya perinatal’noi patologii novorozhdennykh detei. (2012). Pod red. prof. GV Yatsyk. Moscow: Pediatr.

4. Dobryanskyy D., Novikova O., Borysiuk O., Dubrovna Y., Salabay Z. (2016). Clinical effectiveness of hydrolyzed protein preterm formula in prevention of feeding intolerance in preterm very low birth weight infants. Perinatologiya i pediatriya. 1(65): 88-94. doi 10.15574/PP.2016.65.88

5. Zaharova IN, Sugyan NG. (2007). Kishechnye mladencheskie koliki i ih korrekciya. Pediatriya. 2:87–90.

6. Kachurina DR, Saulebekova LO, Almagambetova AN. (2008). Osobennosti psihoehmocional'nogo razvitiya i psiho- somaticheskih disfunkcij u detej s perinatal'nym porazheniem central'noj nervnoj sistemy. Rossijskij vestnik perinatologii i pediatrii. 51;2:41–43.

7. Protokol Enteral'noe vskarmlivanie nedonoshennyh. Klinicheskie rekomendacii. (2015). Moscow.

8. Rylova NV. (2018). Pankreaticheskaya ehlastaza v diagnostike funkcional'nyh i strukturnyh izmenenij podzheludochnoj zhelezy u detej. Prakticheskaya medicina. 2 (113): 66–69.

9. Burrin DG, Stoll B, Jiang R et al. (2000). Minimal enteral nutrient requirements for intestinal growth in neonatal piglets: how much is enough? Am J Clin Nutr. 71: 1603–10. https://doi.org/10.1093/ajcn/71.6.1603; PMid:10837305

10. Butel MJ, Waligora-Dupriet AJ, Szylit O. (2002). Oligofructose and experimentalmodel of neonatal necrotisingenterocolitis. Br J Nutr. 87 (suppl): 213–9. https://doi.org/10.1079/BJNBJN/2002540; https://doi.org/10.1079/BJN/2002540

11. Durie PR, Hamilton JR et al eds. (1996). Pediatric gastrointestinal disease. Philadelphia: Mosby: 143–61.

12. Erasmus HD, Ludwig-Auser HM, Paterson PG, Sun D, Sankaran K. (2002). Enhanced weight gain in preterm infants receiving lactase-treated feeds: a randomized, double-blind, controlled trial. J Pediatr. 141: 532–7. https://doi.org/10.1067/mpd.2002.127499; PMid:12378193

13. Campeotto F, Kapel N, Kalach N, Raz H. (2002). Low levels of pancreatic elastase 1 in stools of preterm Infants. Arch Dis Child Fetal Neonatal Ed. 86: F198-F199. https://doi.org/10.1136/fn.86.3.F198; PMid:11978753 PMCid:PMC1721396

14. Heyman MB. (2006). Lactose intolerance in infants, children andadolescents. Pediatrics. 118: 1279–1286. https://doi.org/10.1542/peds.2006-1721; PMid:16951027

15. Kien CL. (1990). Colonic fermentation of carbohydrate in the premature infant: possible relevance to necrotizing enterocolitis. J Pediatr. 117: 52–8. https://doi.org/10.1016/S0022-3476(05)81131-X

16. Kolack S, Puntis JWL, Lloyd DR et al. (1990). Ontogeny of pancreatic exocrinefunction. Arch Dis Child. 65: 178–81. https://doi.org/10.1136/adc.65.2.178

17. Kruh J. (1982). Effects of sodium butyrate, a new pharmacological agent, oncells in culture. Mol Cell Biochem. 42: 656–82.

18. Lebenthal E, Lee PC. (1980). Development of functional response in human exocrine pancreas. Pediatrics. 66: 556–60. PMid:6159567

19. Luigi Corvaglia, Vittoria Paoletti, Barbara Battistini, Patrizia Simoni, Giacomo Faldella. (2008). Lack of Correlation Between Fecal Elastase-1 Levels and Fecal Nitrogen Excretion in Preterm Infants. JPGN. 47: 517–521. https://doi.org/10.1097/MPG.0b013e3181615b4f

20. McClean P, Weaver LT. (1993). Ontogeny of human pancreatic exocrine function. Arch Dis Child. 68: 62–5. https://doi.org/10.1136/adc.68.1_Spec_No.62; PMid:7679890 PMCid:PMC1029173

21. Murray RD, Boutton TW, Klein PD. (1990). Comparitive absorption of [13C] glucose and [13C] lactose by premature infants. Am J Clin Nutr. 51(1): 59–66. https://doi.org/10.1093/ajcn/51.1.59; PMid:2105054

22. Mustafa Tahtaci, Huseyin Koseoglu, Murat Alisik, Oyku Tayfur Yurekli, Gozde Tahtaci, Ozcan Erel, Osman Ersoy. (2018). Association of Low Fecal Elastase-1 and Non-Ulcer Dyspepsia. J Clin Med. 7(6):155. https://doi.org/10.3390/jcm7060155

23. Kori M, Maayan-Metzger A, Shamir R, Sirota L, Dinari G. (2003). Faecalelastase 1 levels in premature and full term infants. Arch Dis Child Fetal Neonatal Ed. 88: F106-F108. https://doi.org/10.1136/fn.88.2.F106; PMid:12598497 PMCid:PMC1721524

24. Nani Dharmasetiawani, Agus Firmansyah (2003). Elastase-1 concentration in feces of term and preterm infants aged 0–4 months. Med J Indones. 12: 69–72. https://doi.org/10.13181/mji.v12i2.95

25. Nino DF, Sodhi CP, Hackam DJ. (2016). Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol. 13(10): 590–600. Epub 2016/08/18. https://doi.org/10.1038/nrgastro.2016.119.

26. Nissler K1, Von Katte I, Huebner A, Henker J (2001, Jul). Pancreaticelastase 1 in feces of pretermfants. J Pediatr Gastroenterol Nutr. 33(1): 28–31. PMid:11479404

27. Pezzilli R et al. (2005). The ELISA fecal elastase-1 polyclonal assay reacts with different antigens than those of the monoclonal assay. Pancreas. 31(2): 200–1. https://doi.org/10.1097/01.mpa.0000167002.96641.70; PMid:16025011

28. Maarten R Struyvenberg, Camilia R Martin, Steven D. Freedman. (2017). Practical guide to exocrine pancreatic insufficiency — Breaking the myths. BMC Medicine. 15: 29. https://doi.org/10.1186/s12916-017-0783-y; PMid:28183317 PMCid:PMC5301368

29. Ralf G Heine, Fawaz Al Refaee, Prashant Bachina, Julie C De Leon, Lanlan Geng, Sitang Gong, Jose Armando Madrazo, Jarungchit Ngamphaiboon, Christina Ong, Jossie M Rogacion Heine et al. (2017). Lactose intolerance and gastrointestinal cow's milk allergy in infants and children — common misconceptions revisited. World Allergy Organization Journal. 10: 41. https://doi.org/10.1186/s40413-017-0173-0

30. Robert J Shulman, William W Wong, E O'Brian Smith. (2005). Influence of changes in lactase activity and small-intestinal mucosal growth on lactose digestion and absorption in preterm infants. Am J Clin Nutr. 81: 472–9. https://doi.org/10.1093/ajcn.81.2.472; PMid:15699237

31. Sanderson IR. (1999). The physicochemical environment of theneonatal intestine. Am J Clin Nutr. 69(5): 1028–1034. https://doi.org/10.1093/ajcn/69.5.1028s; PMid:10232645

32. Sangild PТ, Sjostrom H, Norin O et al. (1995). The prenatal developmentand glucocorticoid control of brush/border hydrolases in thepig small intestine. Pediatr. Res. 37(2): 207–212.

33. Shulman RJ, Schanler RJ, Lau C, Heitkemper M, Ou C-N, Smith EO. (1998). Early feeding, feeding tolerance, and lactase activity in preterm infants. J Pediatr. 133: 645–9. https://doi.org/10.1016/S0022-3476(98)70105-2

34. Szylit O, Maurage C, Gasqui P et al. (1998). Fecal short-chain fatty acids predictdigestive disorders in premature infants. JPEN J Parenter Enteral Nutr. 22: 136–41. https://doi.org/10.1177/0148607198022003136; PMid:9586790

35. Vanga RR, Tansel A, Sidiq S, El-Serag HB, Othman MO. (2018, Aug). Diagnostic Performance of Measurement of Fecal Elastase-1 in Detection of Exocrine Pancreatic Insufficiency: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 16(8): 1220–1228. https://doi.org/10.1016/j.cgh.2018.01.027. Epub 2018 Jan 31

36. Von Seebach I, Henker J. (1997). Pancreatic elastase 1 in faeces of preterm and term born infants up to 12 months without insufficiency of exocrine pancreatic function. Abstract from the 21st European Cystic Fibrosis Conference (EW6CF), Davos (Switzerland). June 1–6.

37. Wali PD et al. (2012). Comparison of fecal elastase-1 and pancreatic function testing in children. J Pediatr Gastroenterol Nutr. 54(2): 277–80. https://doi.org/10.1097/MPG.0b013e31820b0227; PMid:22266489

38. Werlin SL. Development of the exocrine pancreas. In: Walker AW, Durie PR, Hamilton JR, et al, eds. Pediatric gastrointestinal disease. Philadelphia: Mosby, 1996: 143–61.

39. Zoppi G, Andereotti G, Pajno-Ferrara F, et al. Exocrine pancreasfunction in premature and full term infants. Pediatr Res 1972. 6:880–6. https://doi.org/10.1203/00006450-197212000-00005; PMid:4678558

Article received: Aug 11, 2018. Accepted for publication: Dec 03, 2018.