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Arch Dis Child Fetal Neonatal Ed 2000;83:F198-F202 doi:10.1136/fn.83.3.F198
  • Original article

Leptin and metabolic hormones in preterm newborns

  1. P C Nga,
  2. C W K Lamb,
  3. C H Leea,
  4. G W K Wonga,
  5. T F Foka,
  6. I H S Chanb,
  7. K C Maa,
  8. E Wongc
  1. aDepartment of Paediatrics, Level 6, Clinical Sciences Building, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong, bDepartment of Chemical Pathology, Prince of Wales Hospital, cCenter for Clinical Trials and Epidemiological Research, Prince of Wales Hospital
  1. Prof. Ngpakcheungng{at}cuhk.edu.hk
  • Accepted 16 June 2000

Abstract

AIM To investigate the inter-relation between leptin and other metabolic hormones in preterm and term infants and to explore whether a functional “adipoinsular axis” might exist in preterm newborns.

METHODS A total of 140 preterm and term newborns were prospectively recruited and categorised according to gestation length. Blood samples were taken at 24 hours (day 1), and on day 4–5 of life.

RESULTS Serum leptin, cortisol, free thyroxine, and plasma ACTH on day 1 were significantly higher in term than in preterm infants. The relation between serum leptin and gestation followed a non-linear pattern; the slope of the curve began to increase steeply between 33 and 35 weeks gestation. Serum leptin on day 1 was significantly associated with serum insulin, insulin:glucose ratio, and plasma ACTH in infants less than 34 weeks gestation; serum leptin on day 1 and day 4–5 were significantly correlated with insulin:glucose ratio in infants 34 or more weeks gestation. Significant changes in the pattern of metabolic hormones were observed in the first week of life. Serum insulin and plasma glucose were significantly increased between day 1 and day 4–5; serum leptin was significantly decreased.

CONCLUSIONS The circulating leptin concentration increases markedly after 34 weeks gestation and bears a close temporal relation with the exponential accumulation of body fat mass during that period. The inter-relation between serum leptin and insulin or insulin:glucose ratio before and after 34 weeks gestation indicates that the “adipoinsular axis” is likely to be functional in early (<34 weeks gestation) intrauterine life. The rapid decline in the circulating concentrations of leptin after birth may be of physiological advantage to preterm and term newborns by limiting their body energy expenditure and conserving nutritional reverses for subsequent growth and development.

Key message Serum leptin increases considerably after 34 weeks gestation and bears a close temporal relation with the rapid accumulation of body fat mass during late gestation. The association between serum leptin and insulin or insulin:glucose ratio suggests that the “adipoinsular axis” is likely to be functional in early (less than 34 weeks gestation) intrauterine life

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