The following is a summary of “Fecal Elastase in Preterm Infants to Predict Growth Outcomes,” published in the February 2023 issue of Gastroenterology and Nutrition by Holzapfel, et al.

Babies born prematurely have functional pancreatic insufficiencies and decreased lipase and protease output. Reduced food absorption and growth failure may be caused by developmental pancreatic insufficiency (PI). To evaluate whether levels of fecal elastase (ELA1) are related to growth outcomes in a cohort of preterm newborns, researchers measured the levels across time.

Prospective observational study of 30 newborns aged 24-34 weeks gestation and weighing ≤1250 g at birth who were fed a diet consisting solely of human milk with a fortifier derived from human milk. ELA1 was measured using an ELISA throughout the first two weeks of birth [Early; 7.5 ± 1.8 days of life (DOL)], and once full, enriched feedings were achieved (Late; 63.6 ± 24.1 DOL).

Compared to late ELA1 levels, which were 39.4% higher at 268.0 ± 80.3 µg/g (P = 0.01), early ELA1 levels were 192.2 ± 96.4 µg/g. Babies with early PI (ELA1 < 200 µg/g)) had lower birth weights, gestational ages, lengths, and head circumferences, and were more likely to be male. These elements—but not PI status—alone predicted somatic growth.

In preterm newborns exclusively given human milk, fecal ELA1 levels rose with postnatal age. Further research using fecal was required to use as a predictive biomarker for growth failure in bigger cohorts was requiic function in preterm newborns may serve as a biological component of early postnatal growth failure.