Objectives To explore the relationships between postmenstrual age (PMA), insulin, C-peptide, glucagon and blood glucose concentrations (BGCs) in preterm and term neonates. To compare glucagon-like peptide-1 (GLP-1) concentrations in fed versus never-fed neonates.
Setting Dunedin Hospital Neonatal Intensive Care Unit, New Zealand.
Patients Term or preterm euglycaemic neonates (102) receiving routine blood tests (343 samples).
Interventions None: plasma was obtained from surplus samples from routine clinical care.
Main outcome measures Insulin, C-peptide, GLP-1 and glucagon concentrations were measured in temporal association with BGC.
Results Insulin and C-peptide concentrations were elevated in very preterm infants (PMA≤32 weeks) and decreased to term; this relationship persisted when BGCs were accounted for. Generalised linear mixed models showed that insulin:C-peptide ratio and insulin:BGC ratio decreased significantly with increasing PMA (p<0.001). GLP-1 increased following initial oral feeds regardless of PMA (p<0.001).
Conclusion Preterm neonates exhibit insulin resistance in the absence of hyperglycaemia. Enteral feeds result in an increase in GLP-1. These factors are likely to contribute to the increased risk of hyperglycaemia in premature neonates (PMA<32 weeks).
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Contributors ERS: substantial contribution to conception and design, acquisition of data, analysis and interpretation of data, drafting of the article and final approval of the version to be published. DMR: substantial contribution to conception and design, analysis and interpretation of data, drafting of the article, revising article critically for important intellectual content and final approval of the version to be published. BJW, RSB, NJM: substantial contribution to conception and design, analysis and interpretation of data, revising article critically for important intellectual content and final approval of the version to be published.
Competing interests NJM reports grants from New Zealand Pharmacy Research and Education Fund (NZPERF), during the conduct of the study.
Ethics approval Ethical approval was obtained from the Lower South Regional Ethics Committee, New Zealand.
Provenance and peer review Not commissioned; externally peer reviewed.