An unwell child with a florid rash

Abstract

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 >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 20.2, 95% CI 3.1 to 23.6). Conclusions: Amylin levels are significantly increased in the umbilical cord and Guthrie blood samples in IDM.

‘Peeling paint’ dermatitis as a presenting sign of cystic fibrosis

“…Presentation of cystic fibrosis with dermatitis is rare, with only 21 previously reported cases [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]20,21]. The exact aetiology is not known, however it is postulated to represent the end product of multiple nutritional and metabolic derangements, resulting in a kwashiorkor-like state.…”