Amylin peptide is increased in preterm neonates with feed intolerance.

BACKGROUND: Amylin, a 37-amino-acid peptide hormone, is a potent inhibitor of gastric emptying. It is co-secreted by the pancreatic beta cells in response to enteral nutrient intake. Feed intolerance is common in preterm neonates and often presents as increased gastric residual volume (GRV). It is therefore hypothesised that serum amylin concentrations are raised in preterm neonates with poor gastric emptying, which may contribute to this observed feed intolerance. OBJECTIVE: To determine serum amylin concentrations in feed-intolerant preterm neonates. PATIENTS AND METHODS: Feed-intolerant (nTOL) preterm neonates (GRV >50% of a previous 4 h feed volume on two consecutive occasions) were matched for gestation, birth weight and postnatal age with feed-tolerant (TOL) neonates. Blood samples were analysed for amylin concentration. Seventy neonates were studied with median (interquartile range) gestation of 29 weeks (28-33) and birth weight of 1.3 kg (1.0-1.8). RESULTS: Serum amylin concentration and percentage GRV (median (interquartile range)) were significantly higher in the nTOL (47.9 pmol/l (21.4-79.8), 150% (100-350)) than the TOL (8.7 pmol/l (5.7-16), 5% (0-5)) group (p<0.001). In the nTOL group, a positive correlation was observed between serum amylin and GRV (r = 0.78, 95% CI 0.59 to 0.89, p<0.001), days to reach full enteral feeds (r = 0.40, 95% CI 0.08 to 0.68, p = 0.02), and days to discharge (r = 0.43, 95% CI 0.09 to 0.68, p = 0.01). CONCLUSIONS: Amylin may be responsible for delaying establishment of enteral nutrition in preterm neonates by virtue of its inhibitory effect on gastric emptying. Serum amylin concentrations in these neonates correlate with GRVs and time to reach full enteral feeds.

Controversies in the management of hyperglycemia in the ELBW infant.

Hyperglycemia is a common problem in newborns undergoing intensive care, especially extremely low birth weight (ELBW) infants. There is a lack of consensus with regard to various aspects of management of neonatal hyperglycemia including definition, optimal management strategy as well as short and long term implications. We reviewed the current evidence in this regard. Recent studies suggest that adequate control of hyperglycemia may be beneficial but long-term implications of hyperglycemia and insulin therapy in the ELBW infants are not known. Awaiting further research, it may be pragmatic to use a more operational definition of hyperglycemia and limit insulin therapy to neonates with high risk of osmolar derangement as per the proposed guideline.

Lung function measurement in prematurely born preschool children with and without chronic lung disease.

OBJECTIVE: Prematurely born infants often have recurrent wheeze and long-term respiratory morbidity at follow-up. Assessment of airways obstruction in preschool children is feasible using the interrupter resistance (Rint) but has rarely been examined in preterm children with and without chronic lung disease (CLD). The objective of this study was to determine lung function measured by the interrupter technique, its feasibility in the ambulatory setting and respiratory health in prematurely born preschool children with and without CLD. STUDY DESIGN: Preterm children of 2 to 4 years with severe CLD (>30% oxygen at 36 weeks and discharged home receiving supplemental oxygen) (n=43, median gestational age 27 weeks and median birth weight 995 g) and without CLD (n=33, median gestational age 29 weeks and median birth weight 1366 g) attempting lung function test for the first time were enrolled. Respiratory symptoms score was calculated using a questionnaire. A single set of 10 consecutive Rint measurements was obtained using a portable device (MicroRint). Median of at least five occlusions with consistent shape of mouth pressure-time curves was taken to be a Rint measurement. To assess feasibility the children were categorized as 'satisfactory', 'failure' and 'rejected' depending on the outcome of the test. Outcome variables were respiratory symptoms score and Rint. RESULT: Satisfactory Rint measurement was obtained in 46 (61%) children, 9 (36%) 2-year olds, 17 (65%) 3-year olds and 20 (80%) 4-year olds. As compared with the preterm control children (n=18), CLD children (n=28) had significantly higher respiratory symptoms score (18.5 vs 6, P<0.01) and Rint expressed as absolute values (kPa l(-1)) and z-scores (1.33 vs 1.16 and 1.42 vs 1.0, P<0.01), respectively. CONCLUSION: Rint measurement is feasible in prematurely born children of preschool age in the ambulatory setup. Preschool children with severe CLD may be identified from preterm children without CLD by increased Rint that may be used as a screening tool and as an outcome measure for interventions.

Amylin peptide levels are raised in infants of diabetic mothers.

BACKGROUND: Amylin is a novel 37 amino acid peptide hormone that is co-secreted with insulin from the pancreas in response to food intake. As a potent inhibitor of gastric emptying it plays an important role in the control of carbohydrate absorption. Feed intolerance is common in infants of diabetic mothers (IDM). AIMS: To establish a normal range of amylin levels in healthy neonates, and to determine whether serum amylin levels are raised in IDM. METHODS: A serial sample of 221 infants > or =28 weeks gestation was enrolled prior to delivery over a 12 month period. Blood samples collected immediately after birth (umbilical cord), and at the routine Guthrie test were analysed for amylin and insulin levels. RESULTS: Amylin levels in umbilical cord (n = 181) and Guthrie samples (n = 33) of healthy infants were 5.7 (3.0-9.1) and 6.9 (2.9-9.0) pmol/l respectively. IDM had significantly raised amylin levels in both cord (n = 31; 32.7 pmol/l, 25.9-48.1) and Guthrie samples (n = 8; 18.1 pmol/l, 15.3-23.6). Amylin correlated positively with insulin (n = 42; r = 0.67; 95% CI 0.4 to 0.81), birth weight (r = 0.22; 95% CI 0.08 to 0.36), and gestation (r = 0.18; 95% CI 0.03 to 0.32). Umbilical cord venous amylin levels showed agreement with arterial cord amylin levels (n = 34, mean bias -0.2, 95% CI 3.1 to -3.6). CONCLUSIONS: Amylin levels are significantly increased in the umbilical cord and Guthrie blood samples in IDM.

Unusual presentation of three siblings with familial heterozygous hypobetalipoproteinaemia.

UNLABELLED: We describe three siblings with the unusual presentation of manifest steatorrhoea and vitamin E deficiency mimicking homozygous familial hypobetalipoproteinaemia (FHBL) but whose lipid profile (cholesterol and ApoB) was consistent with heterozygous FHBL. Upper gastrointestinal endoscopy and small intestinal biopsy were normal. We discuss the diagnosis with reference to the relevant literature. CONCLUSION: although rare, familial hypobetalipoproteinaemia should be considered among the causes of manifest steatorrhoea in childhood even without evidence of failure to thrive. Dietary restriction of fat and high dose vitamin E supplementation improves quality of life by reducing stool frequency and may prevent or delay neurological complications.