Pediatric Nutrition in Practice

86 Lentze

particularly in premature infants coping with ex-
ternal feeding. Here, the response of the intestine
to a bolus feed depends on the maturity of the
gut. In small infants before 31 weeks of postcon-
ceptional age, who usually receive low volumes of
continuous enteral feed, ordinary postprandial
activity does not occur [9]. Between 31 and 35
weeks of postconceptional age, postprandial ac-
tivity is induced in infants by giving them larger
volumes of feed. However, the activity remains in
a fasting pattern with superimposed, more ran-
dom postprandial activity. Finally, in infants over
35 weeks of postconceptional age who receive
large volumes of bolus feed, there is a disruption
in cyclical fasting activity and replacement by
continuous activity. Whether this motility pat-
tern can be advanced by pharmacological mea-
sures such as the administration of cortisol re-
mains to be seen [10 , 11].

Conclusions

Feeding of premature infants below 35 weeks of

gestation requires knowledge of physiological

functions at this time. Whereas digestive and ab-

sorptive functions are mostly developed from the

24th week of postconceptional age, gastrointestinal

motility is still not very active. Premature formulas

or fortified breast milk can be given to VLBW in-

fants or extremely LBW infants in small quantities.

From the 31st postconceptional week onward, the

quantity of enteral feeds becomes less of a problem.

As far as macronutrients are concerned, protein is

digested and absorbed well. Carbohydrates, in

form of lactose, are also digested and absorbed

well. Starch can only be digested in small quanti-

ties. The digestion of fat increases quickly from the

26th week of gestation and can be enhanced by ad-

ministration of milk lipase via breast milk.

8 Terada T, Nakanuma Y: Expression of

pancreatic enzymes (α-amylase, tryp-

sinogen, and lipase) during human liver

development and maturation. Gastro-

enterology 1995; 108: 1236–1245.

9 Bisset WM, Watt J, Rivers RP, Milla PJ:

Postprandial motor response of the

small intestine to enteral feeds in pre-

term infants. Arch Dis Child 1989; 64:

1356–1361.

10 Bisset WM, Watt JB, Rivers RP, Milla PJ:

Ontogeny of fasting small intestinal mo-

tor activity in the human infant. Gut

1988; 29: 483–488.

11 Bisset WM, Watt JB, Rivers RP, Milla PJ:

Measurement of small-intestinal motor

activity in the preterm infant. J Biomed

Eng 1988; 10: 155–158.

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Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 83–86

DOI: 10.1159/000360320