Intestinal permeability in relation to birth weight and gestational and postnatal age
R M van Elburg, W P F Fetter, C M Bunkers, H S A Heymans, R M van Elburg, W P F Fetter, C M Bunkers, H S A Heymans
Abstract
Objective: To determine the relation between intestinal permeability and birth weight, gestational age, postnatal age, and perinatal risk factors in neonates.
Study design: Intestinal permeability was measured by the sugar absorption test within two days of birth and three to six days later in preterm and healthy term infants. In the sugar absorption test, the urinary lactulose/mannitol ratio is measured after oral ingestion of a solution (375 mosm) of lactulose and mannitol.
Results: A first sugar absorption test was performed in 116 preterm (26-36 weeks gestation) and 16 term infants. A second test was performed in 102 preterm and nine term infants. In the preterm infants, the lactulose/mannitol ratio was not related to gestational age (r = -0.09, p = 0.32) or birth weight (r = 0.07, p = 0.43). The median lactulose/mannitol ratio was higher if measured less than two days after birth than when measured three to six days later (0.427 and 0.182 respectively, p<0.001). The lactulose/mannitol ratio was higher in preterm infants than term infants if measured within the first 2 days of life (0.404 and 0.170 respectively, p < 0.001), but not different three to six days later (0.182 and 0.123 respectively, p = 0.08). In multiple regression analysis of perinatal risk factors, only umbilical arterial pH correlated with the lactulose/mannitol ratio in preterm infants less than 2 days of age (T = -1.98, p = 0.05).
Conclusions: In preterm infants (26-36 weeks gestation), intestinal permeability is not related to gestational age or birth weight but is higher during the first 2 days of life than three to six days later. It is higher in preterm infants than in healthy term infants only if measured within two days of birth. This suggests rapid postnatal adaptation of the small intestine in preterm infants.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1755997/bin/fn014465.f1.jpg)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1755997/bin/fn014465.f2.jpg)
Figure 3
Lactulose/mannitol (L/M) ratio in 116…
Figure 3
Lactulose/mannitol (L/M) ratio in 116 preterm infants and 16 healthy term infants measured…
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- Age Factors
- Birth Weight / physiology*
- Female
- Gestational Age*
- Humans
- Infant, Newborn / metabolism*
- Infant, Premature / metabolism
- Intestinal Absorption / physiology*
- Lactose / pharmacokinetics
- Male
- Mannitol / pharmacokinetics
- Permeability
- Mannitol
- Lactose
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1755997/bin/fn014465.f3.jpg)
References
- Pediatr Res. 1996 Jun;39(6):985-91
- Pediatr Res. 1998 Oct;44(4):519-23
- Scand J Gastroenterol Suppl. 1997;223:70-8
- Dig Dis Sci. 1998 Sep;43(9):1946-50
- Pediatr Res. 2002 Jan;51(1):64-70
- Arch Dis Child. 1982 Feb;57(2):141-5
- Arch Dis Child. 1984 Mar;59(3):236-41
- J Pediatr Gastroenterol Nutr. 1987 May-Jun;6(3):351-8
- Lancet. 1989 May 6;1(8645):1023-4
- Intensive Care Med. 1992;18(1):38-41
- Pediatrics. 1992 Oct;90(4):561-7
- Arch Surg. 1993 Apr;128(4):453-7
- Gut. 1993 Mar;34(3):354-7
- J Pediatr Gastroenterol Nutr. 1995 Feb;20(2):184-8
- Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 1):1545-8
- Dig Liver Dis. 2000 Apr;32(3):195-200
- J Pediatr Gastroenterol Nutr. 1995 Nov;21(4):383-6
- Pediatr Clin North Am. 1996 Apr;43(2):409-32
- Pediatr Clin North Am. 1996 Apr;43(2):551-71
- Eur J Gastroenterol Hepatol. 1996 Mar;8(3):219-23
- Eur J Pediatr. 1996 Aug;155(8):627-32
Source: PubMed