ORIGINAL ARTICLE

Intestinal permeability in relation to birth weight and gestational and postnatal age

R M van Elburg^1,2, W P F Fetter^1,2, C M Bunkers² and H S A Heymans³

¹ Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
² Department of Neonatology, Isala Clinics, Location Sophia, Zwolle, The Netherlands
³ Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Amsterdam

Correspondence to:
Correspondence to:
Dr van Elburg, Department of Neonatology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands;
rm.vanelburg{at}vumc.nl

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.

Keywords: intestinal permeability; small intestine; digestion; gestational age

Abbreviations: SAT, sugar absorption test; L/M, lactulose/mannitol; NTISS, neonatal therapeutic intervention scoring system

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