The central box represents 25th to 75th percentiles; middle line, median, and the vertical lines, limit lines (range). D’Agostino test for normal distribution was accepted (p value of p=0.18). The amylin level on postnatal day 5 (Guthrie) was 6.9 (2.75-9.50) pmol/L (Table 7 & Figure 25) in 25 healthy preterm infants. Table 7. Summary statistic of amylin concentration and demographic characteristics at postnatal day 5 in healthy preterm infants Healthy Preterm Infants (Guthrie Group) Birth weight (Kg) Gestation (Weeks) Amylin (pmol/L) Median 1.72 33.0 6.9 95% CI 1.56-2.14 32.14-34.00 2.90-8.55 25-75 percentile (IQR) 1.50-2.24 30-35 2.75-9.50 Min-Max 0.83-2.75 26-36 1.0-19.7 Coefficient of Skewness 0.00 (p=0.99) -0.86 (p=0.06) 0.93 (p=0.04) Coefficient of Kurtosis -0.62 (p=0.37) -0.32 (p=0.55) -0.08 (p=0.73) *DP test for Normal distribution p=0.67 Accepted p=0.15 Accepted p=0.13 Accepted * D’Agostino-Pearson test
* D’Agostino-Pearson test Four of five infants in the Guthrie group also had feed intolerance at the time of blood collection. Figure 38. Box-and-whisker plot of Guthrie amylin levels in term IMDM infants The central box represents the values from 25th to 75th percentile, middle line represents the median, and the vertical line joining the horizontal line extends from the minimum to the maximum value (range). The sample size was too small to test normal distribution. There was no difference in the demographic characteristics and plasma amylin levels of term IMDM at birth (umbilical cord) and postnatal day 5 (Guthrie) as shown in Table 13 & Figure 39. Table 13. Demographic characteristic of term IMDM at birth and postnatal day 5 Term IMDM Group Birth (Umbilical Cord) Postnatal Day 5 (Guthrie) p value
Median 2.88 34 32.00 95% CI 1.97-3.51 33 – 35.46 18.51 –45.38 25-75 percentile (IQR) 1.97-3.35 33 – 35.25 18.65-44.27 Min-Max 0.82-4.21 26-36 13.90-90.00 Coefficient of Skewness -0.19 (p=0.73) -1.69 (p=0.00) 1.25 (p<0.04) Coefficient of Kurtosis -0.56 (p=0.49) 2.91 (p=0.05) 1.28 (p=0.24) *D-P test for Normal distribution 0.74 Accept 0.00 Reject <0.06 Accept * D’Agostino-Pearson test Figure 40. Box-and-whisker plot of umbilical cord amylin levels in preterm IMDM infants The central box represents 25th to 75th percentile, middle line represents the median, and the vertical line represents range. D’Agostino-Pearson test for normal distribution of amylin levels was accepted (p=0.06).
We to investigate the role of amylin in newborn infants with feed intolerance which could potentially form the basis of a subsequent clinical trial. Research question: Is amylin elevated in neonates with feed intolerance (delayed gastric emptying)? Aims and Objectives: 1. To determine reference of amylin at birth (umbilical cord) and at 5-7 days (Guthrie) in term and preterm neonates (Study A). 2. To determine amylin levels in IMDM (Study B). 3. To determine amylin in preterm neonates with feed intolerance (study C). design: Prospective observational and case-control study to be conducted simultaneously as 3 sub-studies. Study A- To establish normal ranges of cord and postnatal amylin levels, mothers will be recruited antenatally for umbilical cord blood and inpatient Guthrie blood. Study B- All infants of diabetic mothers will be recruited for cord bloods, Guthrie bloods, and opportunistic bloods taken at the time of routine glucose measurement. Study Preterm infants admitted to neonatal intensive care unit and requiring tube feeding will be recruited. Amylin levels of feed intolerant infants (case) will be compared to feed tolerant infants (control) population: Study A-Term and preterm infants > 24 weeks of gestation, Study B-Term IMDM and preterm IMDM > 24 weeks of gestation and Study Preterm infants > 24 weeks of gestation Exclusion Criteria Infants born less than 24 weeks gestation Congenital malformation Chromosomal anomaly Structural gastrointestinal abnormalities and necrotising enterocolitis Haemoglobin less than 7 g/dl Breast feeding where feed volume cannot be determined Primary outcome measure: Serum amylin levels (pmol/l)