Lactase treated feeds to promote growth and feeding tolerance in preterm infants

Abstract

The only randomized trial to date provides no evidence of significant benefit to preterm infants from adding lactase to their feeds. Further research regarding effectiveness and safety are required before practice recommendations can be made. Randomized controlled trials comparing lactase versus placebo treated feeds and enrolling infants when enteral feeds are introduced are required. The primary and secondary outcomes for effectiveness and safety should include those identified in this review.

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

“…Most current evidence is based on limited studies with low to medium study quality [14][15][16]18,19,21]. A review assessing the effect of cup feeding versus other forms of supplemental enteral feeding, for infants unable to fully breastfeed, reported similar findings as observed in our review [11].…”

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

“…Most current evidence is based on limited studies with low to medium study quality [14][15][16]18,19,21]. A review assessing the effect of cup feeding versus other forms of supplemental enteral feeding, for infants unable to fully breastfeed, reported similar findings as observed in our review [11].…”

The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting

“…After the first feeding, there is a rapid increase in lactase activity to promote digestion of the lactose present in breast milk [24,25]; lactase-mediated hydrolysis of lactose typically exceeds 98% efficiency within five days of starting feeding [26]. Age, feeding, and nutrient composition have been shown to affect the development of intestinal lactase activity [27,28,29]. Premature babies that received early enteral feeding exhibited greater enzyme activity (100%) than infants in the control group (60%) [30].…”

“…Lactose maldigestion is a result of too much lactose relative to lactase capacity. Lactase expression reaches mature levels around term age [27,28,29]; this means that newborns and young children can digest physiological amounts of lactose (i.e., as present in breastmilk) without any problems. Only when they have no or low lactase expression due to congenital lactase deficiency, gastrointestinal infections, or to preterm birth, can the digestion of lactose be compromised.…”

Factors Associated with Anthropometry Z-Scores in Exclusively Breastfed Infants Aged 0–6 Months in 10 Cities of China

“…These diseases or conditions cause damage to the small intestinal mucosa or interfere with the synthesis of lactase, resulting in decreased lactase activity and thereby leading to secondary lactose intolerance. This may also lead to inadequate absorption and utilization of nutrients such as lactose from breast milk in infants, thereby adversely affecting infant growth [ 22 , 83 ]. Therefore, infants with lactose intolerance should be diagnosed early and introduced to appropriate formula interventions to meet their nutritional needs and support normal growth and development.…”

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

“…Most current evidence is based on limited studies with low to medium study quality [14][15][16]18,19,21]. A review assessing the effect of cup feeding versus other forms of supplemental enteral feeding, for infants unable to fully breastfeed, reported similar findings as observed in our review [11].…”

The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting

“…After the first feeding, there is a rapid increase in lactase activity to promote digestion of the lactose present in breast milk [24,25]; lactase-mediated hydrolysis of lactose typically exceeds 98% efficiency within five days of starting feeding [26]. Age, feeding, and nutrient composition have been shown to affect the development of intestinal lactase activity [27,28,29]. Premature babies that received early enteral feeding exhibited greater enzyme activity (100%) than infants in the control group (60%) [30].…”

“…Lactose maldigestion is a result of too much lactose relative to lactase capacity. Lactase expression reaches mature levels around term age [27,28,29]; this means that newborns and young children can digest physiological amounts of lactose (i.e., as present in breastmilk) without any problems. Only when they have no or low lactase expression due to congenital lactase deficiency, gastrointestinal infections, or to preterm birth, can the digestion of lactose be compromised.…”

Factors Associated with Anthropometry Z-Scores in Exclusively Breastfed Infants Aged 0–6 Months in 10 Cities of China

“…These diseases or conditions cause damage to the small intestinal mucosa or interfere with the synthesis of lactase, resulting in decreased lactase activity and thereby leading to secondary lactose intolerance. This may also lead to inadequate absorption and utilization of nutrients such as lactose from breast milk in infants, thereby adversely affecting infant growth [ 22 , 83 ]. Therefore, infants with lactose intolerance should be diagnosed early and introduced to appropriate formula interventions to meet their nutritional needs and support normal growth and development.…”

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

“…Most current evidence is based on limited studies with low to medium study quality [14][15][16]18,19,21]. A review assessing the effect of cup feeding versus other forms of supplemental enteral feeding, for infants unable to fully breastfeed, reported similar findings as observed in our review [11].…”

The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting

“…After the first feeding, there is a rapid increase in lactase activity to promote digestion of the lactose present in breast milk [24,25]; lactase-mediated hydrolysis of lactose typically exceeds 98% efficiency within five days of starting feeding [26]. Age, feeding, and nutrient composition have been shown to affect the development of intestinal lactase activity [27,28,29]. Premature babies that received early enteral feeding exhibited greater enzyme activity (100%) than infants in the control group (60%) [30].…”

“…Lactose maldigestion is a result of too much lactose relative to lactase capacity. Lactase expression reaches mature levels around term age [27,28,29]; this means that newborns and young children can digest physiological amounts of lactose (i.e., as present in breastmilk) without any problems. Only when they have no or low lactase expression due to congenital lactase deficiency, gastrointestinal infections, or to preterm birth, can the digestion of lactose be compromised.…”

Factors Associated with Anthropometry Z-Scores in Exclusively Breastfed Infants Aged 0–6 Months in 10 Cities of China

“…These diseases or conditions cause damage to the small intestinal mucosa or interfere with the synthesis of lactase, resulting in decreased lactase activity and thereby leading to secondary lactose intolerance. This may also lead to inadequate absorption and utilization of nutrients such as lactose from breast milk in infants, thereby adversely affecting infant growth [ 22 , 83 ]. Therefore, infants with lactose intolerance should be diagnosed early and introduced to appropriate formula interventions to meet their nutritional needs and support normal growth and development.…”