Introduction: Amylin, a 37 amino-acid peptide hormone, is a potent inhibitor of gastric emptying and 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 volumes (GRV). We hypothesize that serum amylin levels 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 hour 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 levels. 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: The serum amylin concentration and (%) GRV was significantly higher in the nTOL [47.9 pmol/L (21.4-79.8), 150% (100-350)] compared to TOL [8.7 pmol/L (5.7-16), 5% (0-5), p<0.0001). In the nTOL group, a positive correlation was observed between serum amylin and GRV (r=0.78, 95% CI 0.59-0.89, p<0.0001), days to reach full enteral feeds (r=0.40, 95% CI 0.08-0.68, p=0.02) and days to discharge (r=0.43, 95% CI 0.09-0.68, p=0.01).
Conclusion: 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 enteral feeds.
- Feed intolerance
- Gastric emptying
- Gastric residual volume
- Preterm neonates
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