Presented at the Neonatal Society 2007 Spring Meeting.
Kairamkonda V1, Deorukhkar A1, Bruce C2, Coombs R1, Fraser R2, Mayer A3
1 Department of neonatal intensive care, Jessop Wing, Sheffield, UK
2 Department of obstetrics and gynaecology, Royal Hallamshire Hospital, Sheffield, UK
3 Department of paediatric intensive care, Sheffield Children’s Hospital, Sheffield, UK
Background: Amylin is a 37 amino acid pancreatic peptide hormone that is co-secreted with insulin in response to enteral nutrient intake (1,2). As a potent inhibitor of gastric motility it plays an important role in glucose homeostasis (3). Feed intolerance is common in preterm neonates (4). We hypothesize that raised serum amylin levels in preterm neonates may contribute to this observed feed intolerance. The study therefore aimed to determine serum amylin concentrations in feed-tolerant and feed-intolerant preterm neonates.
Methods: The study was approved by the hospital research ethics committee. Blood from a serial sample of 60 neonates with median (interquartile range) gestation of 29 weeks (28-33) and birth weight of 1.3 kg (1.0-1.8) was analysed for amylin levels. Neonates were identified as feed-intolerant if they had > 50% gastric residual volumes (GRV) of a previous 4 hour feed volume on two consecutive occasions.
Results: Thirty neonates were classif ied as feed-intolerant (nTOL) and 30 as feed-tolerant (TOL) [The GRV was 150% (100-350) and 5% (0-5) of the previous 4 hour feed volume, respectively]. The median serum amylin concentration was significantly higher at 47.9 pmol/L (21.4-79.8) in the feed-intolerant group versus those who were feed-tolerant (8.7 pmol/L (5.7-16), p<0.0001). In the feed-intolerant group, a positive correlation was observed between serum amylin and GRV (r=0.78, p<0.0001), days to reach full feeds (r=0.40, p=0.02) and days to discharge (r=0.43, p=0.01).
Conclusions: Amylin may be responsible in delaying establishment of enteral nutrition in preterm neonates by virtue of its inhibitory effect on gastric emptying. The serum amylin levels in these neonates’ correlate with gastric residual volumes and time to reach full feeds.
References
1. Koda JE Lancet 1992; 339:1179-1180
2. Rink TJ Trends Pharmacol Sci 1993; 14:113-118
3. Young A Diabet Med 1997; 14:S14-S18
4. Reddy PS Indian Pediatr 2000; 37 (8): 837-844