The preterm infant stomach actively degrades milk proteins with increasing breakdown across digestion time

Aim: This study investigated the effect of time post-ingestion on gastric digestion and gastric hormones after feeding preterm infants unfortified and fortified human milk. Methods: Human milk and infant gastric samples were collected from 14 preterm (23-32 weeks birth gestational age) mother-infant pairs within 7-98 days postnatal age. Gastric samples were collected one, two and threehours after beginning of feeding. Samples were analysed for pH, proteolysis, general protease activity and the concentrations of pepsin, gastrin and gastrin-releasing peptide (GRP). One-way ANOVA with repeated measures followed by Tukey's multiple comparisons test was used. Results: Gastric pH was significantly decreased after each hour in the preterm infant stomach from one to threehours postprandial. Proteolysis increased significantly from human milk to gastric contents at one, two and threehours postprandial (by 62, 131% and 181%, p < 0.05). General protease activity increased significantly by 58% from human milk to the gastric contents at twohours postprandial. GRP was present in human milk, whereas gastrin was produced in the infant stomach. Conclusion: Although preterm infants may digest human milk proteins to a lesser extent than term infants, we demonstrated that the preterm infant stomach actively degrades milk proteins with increasing breakdown over digestion time.