Once the infant is able to take a minimal amount of formula or breastmilk by mouth or feeding tube, PERT should be initiated at 2000–4000 lipase units per 120 mL of formula ]. Therefore, in infants with MI and an enterostomy, PI should be assumed and fecal elastase collected at a later date after the gastrointestinal tract is back in continuity and stools are at least of a pasty consistency to confirm diagnosis. Watery stools from either an enterostomy or rectally delivered can result in falsely low fecal elastase values. However, the fecal elastase sample should be collected from rectally delivered, formed stools and not from an enterostomy. Confirmation of PI is most efficiently and effectively done by obtaining a fecal elastase. The majority of infants with CF and MI, whether simple or complex, have pancreatic insufficiency (PI).
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