The sequential changes in intestinal lactase activity of 40 neonates were measured indirectly from the differential uptake and excretion of lactose and the non-metabolisable disaccharide lactulose contained in formula feeds. A daily decline in urinary lactose:lactulose excretion ratios, reflecting a rise in intestinal lactase activity, followed formula feeding. Percentage decline was related directly to gestation: full term infants displayed a fivefold greater decline in lactosuria than infants with a gestation of 28 weeks during the first 10 days of milk feeding. The difference between lactose:lactulose ingestion and excretion ratios suggests that within five days of starting feeds intestinal hydrolysis of lactose exceeds 98% efficiency, even in very preterm infants.
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