530 - Influence of the diet on fecal calprotectin in premature infant

Poster Number: 530
Publication Number: 530.2112

Background: Fecal calprotectin (FC) measurement has been recognized as a non-invasive marker of intestinal inflammation in both adults and children. FC levels have been reported to be elevated in healthy newborns. Controversial results have been reported on the effect of type of feeding of FC in very low birth weight infants.

Objective: To evaluate FC levels during the first 6 weeks after birth in exclusively breastmilk-fed (BF) premature infants and non-exclusive breastmilk-fed infants and compare the levels of FC in relation to the type of diet.

Design/Methods: This is a longitudinal observational prospective cohort study conducted in the Newborn Intensive Care Unit. The study was approved by the IRB and consent was obtained from the parents or legal guardian. Premature infants with gestational age >24 weeks and < 33 weeks, and birth weight < 1500g were included. Data collected included neonatal characteristics, and type of feeds for the first 6 weeks of life. FC levels were obtained during the first week of life and then weekly for the next 6 weeks of life. FC concentrations were determined by enzyme-linked immunosorbent assays (ELISA) in the Transplant Laboratory at University of Miami. FC results were compared based on feeding exposure using the Kruskal-Wallis test and pair-wise Mann-Whitney test.

Results: Thirty-nine premature infants were included in the study (Table 1). A total of 139 stool samples were collected. Levels of calprotectin were classified by type of feeds: no enteral feeds, only breast milk, breast milk and human milk fortifier, formula, and mixed formula. Results indicate significant difference in FC across feed type (Kruskal-Wallis chi-squared = 16.351, p=.002583) (Figure 1). When pair-wise Mann-Whitney tests as a post-hoc tests, was conducted, results indicated that FC levels of formula exposed were significantly lower than no enteral feeds or exposure to exclusive breast milk. There was no correlation of the FC levels over time with postmenstrual (p value=0.617) or post-natal age (p value =0.675).(Figure 2)

Conclusion(s): Our findings show that the introduction of enteral feeds influences the fecal calprotectin levels. FC levels were lower when infants were receiving formula, suggesting a role of the breast milk in the modulation of inflammation and intestinal maturation. This finding is consistent with previous studies showing higher levels of FC in full-term breast-feeding infants when compared to non-breast feed and emphasizes the role of human milk in the gut mucosa maturation and the importance of early exposure to breast milk.