Preterm Birth International Collaborative Australasia Branch: Expert Consensus on Diagnosis and Treatment of Neonatal Lactose Intolerance (2025)

ABSTRACT This consensus aims to standardize the diagnosis and management of neonatal lactose intolerance (LI). A multidisciplinary working group was established under the auspices of the Preterm Birth International Collaborative (Australasia Branch). The development process included a comprehensive literature review of databases, which identified 61 publications. Recommendations were formulated using the Grading of Recommendations, Assessment, Development and Evaluation system for evidence evaluation. A modified Delphi method was used to achieve consensus. The consensus establishes that neonatal LI presents with nonspecific gastrointestinal symptoms, requiring stool assessment for diagnosis. Screening tests include fecal reducing sugar or urinary galactose tests, and the diagnosis is confirmed through elimination testing while excluding mimics. Treatment prioritizes lactase‐supplemented breastfeeding; formula‐fed infants receive lactase or reduced‐lactose formulas. Probiotics with β‐galactosidase activity can be used as an adjuvant therapy, and evidence‐based lactase preparations are recommended, particularly for preterm infants. Treatment duration should be individualized, with a general minimum of 2 weeks; however, the routine use of lactose‐free formula to prevent LI in preterm infants is not recommended. This consensus provides practical evidence‐based guidance to standardize the diagnosis and management of neonatal LI, aiming to reduce variation in practice and improve patient outcomes. It emphasizes the importance of maintaining breastfeeding while incorporating lactase supplementation and highlights the need for further high‐quality research, particularly randomized controlled trials, to refine diagnostic criteria and therapeutic strategies for preterm and very preterm infants. The recommendations are intended to support clinicians in making informed decisions while promoting family‐centered care. Trial Registration International Practice Guidelines Registry Platform (PREPARE‐2024CN606)

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Publication Details

Journal
Pediatric Discovery
Published
2026-03-27
DOI
https://doi.org/10.1002/pdi3.70044
Primary Topic
Digestive system and related health
Type
article
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article

Preterm Birth International Collaborative Australasia Branch: Expert Consensus on Diagnosis and Treatment of Neonatal Lactose Intolerance (2025)

Chang Li, Lingfen Xu, Xianlan Zheng, Ji’an Duan et al.
Pediatric Discovery
Digestive system and related health
article

Preterm Birth International Collaborative Australasia Branch: Expert Consensus on Diagnosis and Treatment of Neonatal Lactose Intolerance (2025)

Chang Li, Lingfen Xu, Xianlan Zheng, Ji’an Duan, Cong Yu, Yunqi Li, W. L. Hao, Jun Tang, Xueyun ren, Yi Ouyang, Lanlan Geng, Yu He, Lijuan Xu, Zhoujie Peng, X. Sheldon Lin, Xiaoli Xie, Yi-Xiang Wang, Yao Shi, Lin Kong, Lei Bao, Zhengli Wang, Falin Xu, Liping Xu, Wenyan Tang, Fang Li, Guoping Chen, Qiao Shen, Zhongliang Li, Hui Wu, Qian Zhang, Long Chen, Zhi Zhao, Xingwang Zhu, Yingli Wu, Rong Ju, Xiaomei Tong, Junli Li, Siqi Zhuang, Wei Zhou, Tao Pan, Zheng Chen, Juan Zhang, Shuping Han
article en

Abstract

ABSTRACT This consensus aims to standardize the diagnosis and management of neonatal lactose intolerance (LI). A multidisciplinary working group was established under the auspices of the Preterm Birth International Collaborative (Australasia Branch). The development process included a comprehensive literature review of databases, which identified 61 publications. Recommendations were formulated using the Grading of Recommendations, Assessment, Development and Evaluation system for evidence evaluation. A modified Delphi method was used to achieve consensus. The consensus establishes that neonatal LI presents with nonspecific gastrointestinal symptoms, requiring stool assessment for diagnosis. Screening tests include fecal reducing sugar or urinary galactose tests, and the diagnosis is confirmed through elimination testing while excluding mimics. Treatment prioritizes lactase‐supplemented breastfeeding; formula‐fed infants receive lactase or reduced‐lactose formulas. Probiotics with β‐galactosidase activity can be used as an adjuvant therapy, and evidence‐based lactase preparations are recommended, particularly for preterm infants. Treatment duration should be individualized, with a general minimum of 2 weeks; however, the routine use of lactose‐free formula to prevent LI in preterm infants is not recommended. This consensus provides practical evidence‐based guidance to standardize the diagnosis and management of neonatal LI, aiming to reduce variation in practice and improve patient outcomes. It emphasizes the importance of maintaining breastfeeding while incorporating lactase supplementation and highlights the need for further high‐quality research, particularly randomized controlled trials, to refine diagnostic criteria and therapeutic strategies for preterm and very preterm infants. The recommendations are intended to support clinicians in making informed decisions while promoting family‐centered care. Trial Registration International Practice Guidelines Registry Platform (PREPARE‐2024CN606)

Pediatric Discovery
Weifang Medical University (CN), Harbin Medical University (CN), Sun Yat-sen University (CN), Chongqing University (CN), Shanxi Medical University (CN), Soochow University (TW), Jilin University (CN), Peking University (CN), Sichuan University (CN), Kunming Medical University (CN), Soochow University (CN), West China Second University Hospital of Sichuan University (CN), Chengdu Women's and Children's Central Hospital (CN), Shaanxi Provincial People's Hospital (CN), The Seventh Affiliated Hospital of Sun Yat-sen University (CN), Sun Yat-sen Memorial Hospital (CN), Nanjing Maternity and Child Health Care Hospital (CN), Zhangzhou Municipal Hospital of Fujian Province (CN), Qujing Normal University (CN), Guangzhou Women and Children Medical Center (CN), Jiangxi Maternal and Child Health Hospital (CN), Chongqing Maternal and Child Health Hospital (CN), Children's Hospital of Zhejiang University (CN), Shandong Provincial Hospital (CN), First Affiliated Hospital of Kunming Medical University (CN), First Hospital of Jilin University (CN), People's Hospital of Bishan District (CN), Peking University Third Hospital (CN), Third Affiliated Hospital of Zhengzhou University (CN), First Affiliated Hospital of Soochow University (CN), First Affiliated Hospital of Harbin Medical University (CN), Children's Hospital of Chongqing Medical University (CN), Weifang Maternity and Child Care Hospital (CN), Shanxi Provincial People’s Hospital (CN), Affiliated Hospital of Jining Medical University (CN), Children’s Hospital of Fudan University Xiamen Branch (CN), Shandong First Medical University (CN), Xiamen Maternal and Child Health Hospital (CN), Chongqing Medical and Pharmaceutical College (CN), Chongqing Medical University (CN), China Medical University (CN), Guangzhou Medical University (CN)
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Digestive system and related health
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