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Amino Acid-Based Formula in Premature Infants with Feeding Intolerance: Comparison of Fecal Calprotectin Level

  • Jang, Hyo-Jeong (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Park, Jae Hyun (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Kim, Chun Soo (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Lee, Sang Lak (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Lee, Won Mok (Department of Laboratory Medicine, Keimyung University School of Medicine)
  • Received : 2017.02.04
  • Accepted : 2017.12.29
  • Published : 2018.07.15

Abstract

Purpose: We investigated fecal calprotectin (FC) levels in preterm infants with and without feeding intolerance (FI), and compared the FC levels according to the type of feeding. Methods: The medical records of 67 premature infants were reviewed retrospectively. The fully enteral-fed infants were classified into two groups; the FI group (29 infants) and the control group (31 infants). Seven infants with necrotizing enterocolitis, sepsis, and perinatal asphyxia were excluded. If breast milk (BM) or preterm formula (PF) could not be tolerated by infants with FI, amino acid-based formula (AAF) was tried temporarily. Once FI improved, AAF was discontinued, and BM or PF was resumed. We investigated the FC levels according to the type of feeding. Results: Significant differences were found in gestational age, birth weight, age when full enteral feeding was achieved, and hospital stay between the FI and control group (p<0.05). The FC levels in the FI group were significantly higher than those in the control group (p<0.05). The FC levels in the AAF-fed infants with FI were significantly lower than those in the BM- or PF-fed infants (p<0.05). The growth velocities (g/d) and z scores were not significantly different between the FI and control group (p>0.05). Conclusion: The FC levels in AAF-fed infants with FI showed significantly lower than those in the BM- or PF-fed infants with FI. The mitigation of gut inflammation through the decrease of FC levels in AAF-fed infants with FI could be presumed.

Keywords

References

  1. Moore TA, Wilson ME. Feeding intolerance: a concept analysis. Adv Neonatal Care 2011;11:149-54. https://doi.org/10.1097/ANC.0b013e31821ba28e
  2. Berseth CL, Nordyke CK, Valdes MG, Furlow BL, Go VL. Responses of gastrointestinal peptides and motor activity to milk and water feedings in preterm and term infants. Pediatr Res 1992;31:587-90. https://doi.org/10.1203/00006450-199206000-00010
  3. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285-91. https://doi.org/10.1542/peds.110.2.285
  4. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292:2357-65. https://doi.org/10.1001/jama.292.19.2357
  5. Hay WW Jr. Aggressive nutrition of the preterm infant. Curr Pediatr Rep 2013;1:10.1007/s40124-013-0026-4.
  6. Mansi Y, Abdelaziz N, Ezzeldin Z, Ibrahim R. Randomized controlled trial of a high dose of oral erythromycin for the treatment of feeding intolerance in preterm infants. Neonatology 2011;100:290-4. https://doi.org/10.1159/000327536
  7. Indrio F, Riezzo G, Cavallo L, Di Mauro A, Francavilla R. Physiological basis of food intolerance in VLBW. J Matern Fetal Neonatal Med 2011;24 Suppl 1:64-6. https://doi.org/10.3109/14767058.2011.607583
  8. Lebenthal E, Lee PC, Heitlinger LA. Impact of development of the gastrointestinal tract on infant feeding. J Pediatr 1983;102:1-9. https://doi.org/10.1016/S0022-3476(83)80276-5
  9. Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev 2013;89 Suppl 2:S13-20.
  10. Hyman PE, Clarke DD, Everett SL, Sonne B, Stewart D, Harada T, et al. Gastric acid secretory function in preterm infants. J Pediatr 1985;106:467-71. https://doi.org/10.1016/S0022-3476(85)80682-X
  11. Hyman PE, Feldman EJ, Ament ME, Byrne WJ, Euler AR. Effect of enteral feeding on the maintenance of gastric acid secretory function. Gastroenterology 1983;84:341-5.
  12. Mihatsch WA, Franz AR, Hogel J, Pohlandt F. Hydrolyzed protein accelerates feeding advancement in very low birth weight infants. Pediatrics 2002;110:1199-203. https://doi.org/10.1542/peds.110.6.1199
  13. Raimondi F, Spera AM, Sellitto M, Landolfo F, Capasso L. Amino acid-based formula as a rescue strategy in feeding very-low-birth-weight infants with intrauterine growth restriction. J Pediatr Gastroenterol Nutr 2012; 54:608-12. https://doi.org/10.1097/MPG.0b013e3182483e8f
  14. Fagerhol MK, Dale I, Andersson T. A radioimmunoassay for a granulocyte protein as a marker in studies on the turnover of such cells. Bull Eur Physiopathol Respir 1980;16 Suppl:273-82.
  15. Lamb CA, Mansfield JC. Measurement of faecal calprotectin and lactoferrin in inflammatory bowel disease. Frontline Gastroenterol 2011;2:13-8. https://doi.org/10.1136/fg.2010.001362
  16. Mussa R, Khashana A, Kamel N, Elsharqawy SE. Fecal calprotectin levels in preterm infants with and without feeding intolerance. J Pediatr 2016;92:486-92. https://doi.org/10.1016/j.jped.2015.11.007
  17. Pergialiotis V, Konstantopoulos P, Karampetsou N, Koutaki D, Gkioka E, Perrea DN, et al. Calprotectin levels in necrotizing enterocolitis: a systematic review of the literature. Inflamm Res 2016;65:847-52. https://doi.org/10.1007/s00011-016-0963-9
  18. Kapel N, Campeotto F, Kalach N, Baldassare M, Butel MJ, Dupont C. Faecal calprotectin in term and preterm neonates. J Pediatr Gastroenterol Nutr 2010;51:542-7. https://doi.org/10.1097/MPG.0b013e3181e2ad72
  19. Lim JS, Lim SW, Ahn JH, Song BS, Shim KS, Hwang IT. New Korean reference for birth weight by gestational age and sex: data from the Korean Statistical Information Service (2008-2012). Ann Pediatr Endocrinol Metab 2014;19:146-53. https://doi.org/10.6065/apem.2014.19.3.146
  20. Li F, Ma J, Geng S, Wang J, Ren F, Sheng X. Comparison of the different kinds of feeding on the level of fecal calprotectin. Early Hum Dev 2014;90:471-5. https://doi.org/10.1016/j.earlhumdev.2014.06.005
  21. Zoppelli L, Guttel C, Bittrich HJ, Andree C, Wirth S, Jenke A. Fecal calprotectin concentrations in premature infants have a lower limit and show postnatal and gestational age dependence. Neonatology 2012; 102:68-74. https://doi.org/10.1159/000337841
  22. Rouge C, Butel MJ, Piloquet H, Ferraris L, Legrand A, Vodovar M, et al. Fecal calprotectin excretion in preterm infants during the neonatal period. PLoS One 2010;5:e11083. https://doi.org/10.1371/journal.pone.0011083
  23. Savino F, Castagno E, Calabrese R, Viola S, Oggero R, Miniero R. High faecal calprotectin levels in healthy, exclusively breast-fed infants. Neonatology 2010;97: 299-304. https://doi.org/10.1159/000255161
  24. Campeotto F, Kalach N, Lapillonne A, Butel MJ, Dupont C, Kapel N. Time course of faecal calprotectin in preterm newborns during the first month of life. Acta Paediatr 2007;96:1531-3. https://doi.org/10.1111/j.1651-2227.2007.00457.x
  25. Yang Q, Smith PB, Goldberg RN, Cotten CM. Dynamic change of fecal calprotectin in very low birth weight infants during the first month of life. Neonatology 2008;94:267-71. https://doi.org/10.1159/000151645
  26. Sangild PT. Gut responses to enteral nutrition in preterm infants and animals. Exp Biol Med (Maywood) 2006;231:1695-711. https://doi.org/10.1177/153537020623101106
  27. Kim YJ. Enteral nutrition and its clinical application. Korean J Pediatr Gastroenterol Nutr 2009;12(Suppl 1):S27-36.
  28. Wu G, Jaeger LA, Bazer FW, Rhoads JM. Arginine deficiency in preterm infants: biochemical mechanisms and nutritional implications. J Nutr Biochem 2004;15: 442-51. https://doi.org/10.1016/j.jnutbio.2003.11.010
  29. Buddington RK, Elnif J, Puchal-Gardiner AA, Sangild PT. Intestinal apical amino acid absorption during development of the pig. Am J Physiol Regul Integr Comp Physiol 2001;280:R241-7. https://doi.org/10.1152/ajpregu.2001.280.1.R241
  30. Bjornvad CR, Schmidt M, Petersen YM, Jensen SK, Offenberg H, Elnif J, et al. Preterm birth makes the immature intestine sensitive to feeding-induced intestinal atrophy. Am J Physiol Regul Integr Comp Physiol 2005;289:R1212-22. https://doi.org/10.1152/ajpregu.00776.2004
  31. Rigo J, Salle BL, Picaud JC, Putet G, Senterre J. Nutritional evaluation of protein hydrolysate formulas. Eur J Clin Nutr 1995;49 Suppl 1:S26-38.
  32. Szajewska H, Albrecht P, Stoitiska B, Prochowska A, Gawecka A, Laskowska-Klita T. Extensive and partial protein hydrolysate preterm formulas: the effect on growth rate, protein metabolism indices, and plasma amino acid concentrations. J Pediatr Gastroenterol Nutr 2001;32:303-9. https://doi.org/10.1097/00005176-200103000-00013
  33. Zuppa AA, Visintini F, Cota F, Maggio L, Romagnoli C, Tortorolo G. Hydrolysed milk in preterm infants: an open problem. Acta Paediatr Suppl 2005;94:84-6. https://doi.org/10.1080/08035320510043600

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