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

ObjectiveTo evaluate the effects of pancreatic enzyme substitution (PES) in selected very low birthweight (VLBW) infants with poor postnatal growth despite intensified nutritional support.DesignRetrospective historic cohort study with matched controls.SettingSingle level III neonatal intensive care unit.PatientsInfants 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).InterventionsPES 15–93 mg/g fat with enteral feeds.Main outcome measuresThe 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).ResultsGestational 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.ConclusionsPES 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

Increased postprandial responses of GLP-1 and GIP in patients with chronic pancreatitis and steatorrhea following pancreatic enzyme substitution

We aimed to investigate how assimilation of nutrients affects the postprandial responses of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) and to evaluate the effect of pancreatic enzyme substitution (PES) on insulin secretion in patients with chronic pancreatitis (CP) and pancreatic exocrine insufficiency (PEI). Eight male patients with CP and PEI were studied. Blood was sampled frequently on two separate days after ingestion of a liquid meal with and without PES, respectively. Eight healthy male subjects served as a control group. β-Cell responsiveness was estimated as changes in insulin secretion rates in response to changes in postprandial plasma glucose (PG). There was no difference in the PG incremental area under curve (AUC) for patients with and without PES [406 ± 100 vs. 425 ± 80 mM·4 h (mean ± SE), P = 0.8]. The response of total GLP-1 was higher after PES (AUC: 7.8 ± 1.2 vs. 5.3 ± 0.6 nM·4 h, P = 0.01), as was the response of total GIP (AUC: 32.7 ± 7.5 vs. 21.1 ± 8.3 nM·4 h, P = 0.01). Concurrently, both plasma insulin, plasma C-peptide, and total insulin secretion increased after PES (AUC: 17.7 ± 4.2 vs. 13.6 ± 2.9 nM·4 h, P = 0.02; 237 ± 31.4 vs. 200 ± 27.4 nM·4 h, P = 0.005; and 595 ± 82 vs. 497 ± 80 pmol·kg−1·4 h, P = 0.01, respectively). β-Cell responsiveness to glucose was not significantly different on the two study days for patients with CP. These results suggest that the secretion of GLP-1 and GIP is under influence of the digestion and absorption of nutrients in the small intestine and that PES increases insulin secretion.

Meconium Ileus

This review of the subject is based on 61 patients seen during a 10-year period at the Children's Medical Center in Boston. Attention is concentrated on 20 patients who had survived from 7 months to 13 years. The intestinal obstruction from viscid meconium was relieved by surgery in 15 patients and by medical means in 5. Details of the immediate surgical and medical treatment are given. The subsequent treatment is along generally acceptable lines. The ultimate prognosis depended upon the severity of the pulmonary lesion which usually developed during the first few months of life. The appearance of this manifestation could not be prevented by careful attention to the nutrition, pancreatic enzyme substitution therapy or prophylactic antibiotics. The course of patients surviving meconium ileus does not differ materially from those patients whose first manifestations of the disease appear in the first months of life without antecedent meconium ileus. The literature concerning meconium ileus is thoroughly reviewed.