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Nutrient Metabolism

Preterm Birth Affects the Intestinal Response to Parenteral and Enteral Nutrition in Newborn Pigs^{1 ,2}

Per T. Sangild^*3, Yvette M. Petersen^*, Mette Schmidt^*, Jan Elnif^*, Thomas K. Petersen, Randal K. Buddington^**, Gorm Greisen, Kim F. Michaelsen and Douglas G. Burrin

^* Divisions of Nutrition and Reproduction, Royal Veterinary and Agricultural University, Frederiksberg DK-1870, Denmark; Leo Pharmaceutical Products, Department of Pharmacology, Ballerup DK-2750, Denmark; ^** Department of Biological Sciences and the College of Veterinary Medicine, Mississippi State University, Starkville, MS 39762; Neonatology Clinic, State University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark; Research Department of Human Nutrition, Royal Veterinary and Agricultural University, Frederiksberg, Denmark; and the U.S. Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center, Houston, TX 77030

³To whom correspondence should be addressed. E-mail: psa{at}kvl.dk.

Maturation of gastrointestinal (GI) function in neonates is stimulated by enteral nutrition, whereas parenteral nutrition induces GI atrophy and malfunction. We investigated whether preterm birth alters the GI responses to parenteral and enteral nutrition. Pigs were delivered either preterm (107 d gestation) or at term (115 d gestation) and fed total parenteral nutrition (TPN) or enteral sow’s milk (ENT) for 6 d after birth. Immaturity of the preterm pigs was documented by reduced blood pH, oxygen saturation and neutrophil granulocyte function, impaired intestinal immunoglobulin G uptake from colostrum, and altered relative weights of visceral organs (small intestine, liver, spleen, pancreas, and adrenals). For both ages at delivery, increases occurred in pancreatic weight (30–75%) and amylase activity (0.5- to 13-fold) after birth, but much more in ENT than in TPN pigs (P < 0.05). Six days of TPN feeding was associated with reduced intestinal weight for both delivery groups (60% of values in ENT, P < 0.001), but only in term TPN pigs was the weight lower than at birth (-20%, P < 0.05). Likewise, it was only in term TPN pigs that intestinal maltase activity increased, compared with ENT, and the absorption of glucose and proline decreased. Only in preterm pigs did TPN feeding increase lactase activity (+50% compared with ENT, P < 0.05). For both delivery ages, the mRNA of lactase-phloridzin hydrolase and sodium-coupled glucose transporter 1 were increased in TPN, compared with ENT. In conclusion, the trophic effect of enteral vs. parenteral nutrition on the GI tract is also present after preterm birth, but the postnatal maturation of many GI functions is modified, compared with term birth. The effects of nutritional regimen on the maturation of the gut epithelium in neonates depend on gestational age at birth.

KEY WORDS: • ontogeny • birth • nutrient absorption • brush-border enzymes • development

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