Intestinal permeability in newborns with necrotizing enterocolitis and controls: Does the sugar absorption test provide guidelines for the time to (re-)introduce enteral nutrition?
M. Piena-spoel et al., Intestinal permeability in newborns with necrotizing enterocolitis and controls: Does the sugar absorption test provide guidelines for the time to (re-)introduce enteral nutrition?, J PED SURG, 36(4), 2001, pp. 587-592
Background: In necrotizing enterocolitis (NEC), (sub)mucosal edema, hemorrh
age, ulceration, or necrosis will disturb intestinal integrity, as reflecte
d by an increased intestinal permeability. Enteral substrate is therefore w
ithheld for a variable period up to 3 weeks tin many clinics). The authors
used the sugar absorption test to measure intestinal permeability changes i
n surgically treated necrotizing enterocolitis patients and surgical contro
ls to evaluate the usefulness of this test in timing the (re-)introduction
of enteral feeding in NEC patients as intestinal integrity recovers.
Methods: Changes in intestinal permeability to lactulose and rhamnose were
evaluated prospectively in 13 children with NEC and 10 operated control pat
ients. The patients were given 1 mL/kg body weight lactulose/rhamnose solut
ion at different time intervals after admission. The lactulose to rhamnose
(UR) ratio was determined by gaschromatography in 4-hour urine samples.
Results: The UR ratios in NEC patients were increased for prolonged periods
of time with a tendency to decrease in the third week after the start of N
EC, However, in some cases, the increased UR ratios even exceeded the 3-wee
k period of starvation. High peaks in the UR ratio were seen in patients su
ffering from bowel perforation or sepsis. Compared with necrotizing enteroc
olitis patients, UR ratios of control patients were increased only in the f
irst days after surgery and normalized more rapidly. The results of the VR
tests in this study corroborated the clinical condition of the patients.
Conclusions: The sugar absorption test shows an individual variability in t
he recovery of intestinal permeability in a group of seriously ill newborns
with advanced stages of NEC. An individual approach in restarting enteral
nutrition seems to be justified; however, the optimal time-point to restart
enteral nutrition cannot be determined by the sugar absorption test alone.
Combining parameters of intestinal integrity and function could enable a m
ore accurate determination of this optimal timepoint.