Effect of enteral administration of insulin on intestinal development and feeding tolerance in preterm infants: a pilot study

Objective: To determine in a pilot study whether enteral administration of insulin to preterm infants (26-29 weeks of gestational age) would enhance gastrointestinal development and reduce feed intolerance without adverse effects. Design: Eight preterm infants were given 4 U/kg/day insulin enterally from 4 to 28 days of age. Lactase activity was measured at 28 days of age, while measures of feed intolerance were made throughout the hospital stay. The results were compared with those of a matched historical cohort of 80 preterm infants. Setting: Tertiary care, university affiliated hospital. Main outcome measures: Lactase activity and feed intolerance. Results: No adverse effects, such as hypoglycaemia, were observed after administration of insulin. The infants who received insulin had higher lactase activity and less feed intolerance than the controls (30% shorter time to full enteral feeds; fewer gastric residuals per infant). Conclusions: These preliminary data suggest that enteral insulin administration may be of benefit in reducing feed intolerance in preterm infants. A randomised, blinded trial is warranted.