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Splanchnic bed metabolism of glucose in preterm neonates^1,2,3

¹ From Erasmus MC-Sophia Children’s Hospital, Department of Pediatrics, Rotterdam, Netherlands (SRDvdS, DLW, HAB, DT, and JBvG), and the US Department of Agriculture Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston (BS, DGB, and JBvG).

Background: Glucose is a major oxidative substrate for intestinal energy generation in neonatal animals; however, few data in preterm infants are available. Early administration of enteral nutrition, including glucose, may be an effective strategy to support intestinal adaptation to extrauterine life in preterm neonates.

Objective: The purpose of the present study was to quantify the first-pass uptake and oxidation of glucose by the splanchnic tissues (intestine and liver) in human neonates.

Design: Eight preterm infants [birth weight ( ± SD): 1.19 ± 0.22 kg, gestational age: 29 ± 1 wk] were studied while they received 2 different enteral intakes (A: 40% enteral, 60% parenteral, total glucose intake = 7.5 ± 0.5 mg · kg^–1 · min^–1, and B: 100% enteral, total glucose intake = 7.8 ± 0.4 mg · kg^–1 · min^–1). Splanchnic and whole-body glucose kinetics were measured by use of dual-tracer techniques.

Results: During both feeding periods, approximately one-third of dietary glucose intake was utilized during the first pass by the splanchnic tissues. More than three-quarters of this utilized glucose was oxidized in both periods (79 ± 36% with A and 84 ± 45% with B). Whole-body glucose oxidation was substantial under both circumstances: 72 ± 5% and 77% ± 6% of the glucose flux was oxidized during partial (A) and full (B) enteral feeding, respectively.

Conclusions: Approximately one-third of dietary glucose is utilized during the first pass by the splanchnic tissues, irrespective of the dietary intake. Most of the utilized glucose is used for energy generation.

Key Words: Enteral nutrition • first-pass glucose uptake • intestine • oxidation • parenteral nutrition • preterm infants • stable isotopes

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