Department of Neonatology, Charité University Medical Center, Berlin, Germany.
J Pediatr Gastroenterol Nutr. 2013 May;56(5):532-6. doi: 10.1097/MPG.0b013e31827fb091.
The aim of the present study was to better understand the exocrine pancreatic function of extremely preterm infants.
Pancreatic-specific elastase 1 (PSE1) activity was determined in spot stool samples of 69 preterm infants of gestational age <32 weeks and birth weight <1250 g. Assays were conducted on samples collected at 2 (N = 56), 4 (N = 46), and 6 weeks of age (N = 23).
PSE1 activity increased from week 2 (median [interquartile range] 84 [48-187] μg/g) to week 4 (164 [87-251 μg/g; P < 0.001) but not thereafter (169 [82-298] μg/g at week 6). The maturational increase in PSE1 activity was observed only in infants of gestational age <28 weeks (P < 0.001). At 2 weeks after birth, PSE1 levels were lower in infants of gestational age <28 weeks than in infants of gestational age ≥ 28 weeks (77 [43-110] vs 165 [56-300] μg/g; P = 0.019), but this difference was less pronounced at 4 weeks (153 [77-226] vs 230 [108-503] μg/g; P = 0.070) and had disappeared by 6 weeks (163 [76-258] vs 175 [85-418] μg/g; P = 0.576). In infants on full enteral feeding regimens 4 weeks after birth, PSE1 levels were associated with weight gain per unit of energy intake (Rs = 0.431; P = 0.005). This measure of weight gain was lower (P = 0.040) in infants with PSE1 levels <200 μg/g (0.110 [0.081-0.139] g/kcal, N = 25) than in those with PSE1 levels ≥ 200 μg/g (0.139 [0.117-0.157] g/kcal, N = 15). Administration of pancreatic enzymes to infants showing PSE1 excretion levels <200 μg/g did not enhance weight gain.
: Extremely preterm infants have limited exocrine pancreatic function during the first weeks of life, which may contribute to growth failure.
本研究旨在更好地了解极早产儿的外分泌胰腺功能。
检测了 69 名胎龄<32 周、出生体重<1250g 的早产儿的粪便弹性蛋白酶 1（PSE1）活性。在 2 周（N=56）、4 周（N=46）和 6 周龄（N=23）时采集样本进行检测。
PSE1 活性从第 2 周（中位数[四分位数间距]84[48-187]μg/g）增加到第 4 周（164[87-251]μg/g；P<0.001），但之后没有增加（第 6 周时为 169[82-298]μg/g）。PSE1 活性的成熟性增加仅见于胎龄<28 周的婴儿（P<0.001）。出生后 2 周时，胎龄<28 周的婴儿的 PSE1 水平低于胎龄≥28 周的婴儿（77[43-110]与 165[56-300]μg/g；P=0.019），但在第 4 周时差异不明显（153[77-226]与 230[108-503]μg/g；P=0.070），到第 6 周时已消失（163[76-258]与 175[85-418]μg/g；P=0.576）。在出生后 4 周时已接受全肠内喂养方案的婴儿中，PSE1 水平与单位能量摄入的体重增加相关（Rs=0.431；P=0.005）。PSE1 水平<200μg/g（25 例，N=25）的婴儿的体重增加量（0.110[0.081-0.139]g/kcal）低于 PSE1 水平≥200μg/g（15 例，N=15）的婴儿（0.139[0.117-0.157]g/kcal；P=0.040）。对 PSE1 排泄水平<200μg/g 的婴儿给予胰酶治疗并未促进体重增加。
极早产儿在生命的最初几周内外分泌胰腺功能有限，这可能导致生长不良。
