Blood Level of Inter-Alpha Inhibitor Proteins Distinguishes Necrotizing Enterocolitis From Spontaneous Intestinal Perforation (original) (raw)
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Annals of Surgery, 2013
Objectives: To evaluate the use of gut barrier proteins, liver-fatty acid binding protein (L-FABP), intestinal-fatty acid binding protein (I-FABP), and trefoil factor 3 (TFF3), as biomarkers for differentiating necrotizing enterocolitis (NEC) from septicemic/control infants and to identify the most severely affected surgical NEC from nonsurgical NEC infants. Background: Clinical features and routine radiologic investigations have low diagnostic utilities in identifying surgical NEC patients. Methods: The diagnostic utilities of individual biomarkers and the combination of biomarkers, the LIT score, were assessed among the NEC (n = 20), septicemia (n = 40), and control groups (n = 40) in a case-control study for the identification of proven NEC and surgical NEC infants. Results: Plasma concentrations of all gut barrier biomarkers and the LIT score were significantly higher in the NEC than in the septicemia or control group (P < 0.01). Using median values of biomarkers and the LIT score in the NEC group as cutoff values for identifying NEC from septicemic/control cases, all had specificities of 95% or more and sensitivities of 50%. Significantly higher levels of biomarkers and the LIT score were found in infants with surgical NEC than in nonsurgical NEC cases (P ≤ 0.02). The median LIT score of 4.5 identified surgical NEC cases with sensitivity and specificity of 83% and 100%%, respectively. A high LIT score of 6 identified nonsurvivors of NEC with sensitivity and specificity of 78% and 91%, respectively. Conclusions: The LIT score can effectively differentiate surgical NEC from nonsurgical NEC infants and nonsurvivors of NEC from survivors at the onset of clinical presentation. Frontline neonatologists and surgeons may, therefore, target NEC infants who are most in need of close monitoring and those who may benefit from early surgical intervention.
Biomarkers for Infants at Risk for Necrotizing Enterocolitis: Clues to Prevention?
Pediatric Research, 2009
Necrotizing enterocolitis (NEC) is the most common severe gastrointestinal emergency that affects premature newborns. This disease often has a rapid onset with few, if any, antecedent signs that can be used to reliably predict its occurrence. Its rapid onset and progression to death, as well as its severe morbidity when the infant survives, begs for early diagnostic tools that may be used in determining those infants who would be at greatest risk for development of the disease and for whom early preventative measures could be targeted. Although studies have suggested efficacy of several techniques such as breath hydrogen, inflammatory mediators in blood, urine or stool, and genetic markers, these all have drawbacks limiting their use. The application of newly developed "omic" approaches may provide biomarkers for early diagnosis and targeted prevention of this disease.
Intestinal perforation in very-low-birth-weight infants with necrotizing enterocolitis
Journal of Pediatric Surgery, 2013
To identify risk factors for intestinal perforation in very-low-birth-weight (VLBW) infants with necrotizing enterocolitis (NEC). Methods: Retrospective case-control study over a 10-year period, using univariate and multivariate logistic regression analyses to compare all VLBW infants treated for perforated NEC, with two age and weight-matched groups: infants with non-perforated NEC and infants without NEC. Results: Twenty infants with perforated NEC were matched to 20 infants with non-perforated NEC and 38 infants without NEC. Infants with perforated NEC were younger (pb0.01) and had higher rates of abdominal distention, metabolic acidosis, hyperglycemia and elevated liver enzymes (pb0.05). On logistic regression analysis, abdominal distention was associated with an increased risk of intestinal perforation (OR 39.8, 95% CI 2.71-585) and late onset of NEC (one-day increments) was associated with a decreased risk (OR 0.93, 95% CI 0.87-1.0). Conclusion: Identification of abdominal distention at an early age in VLBW infants should lead to increased vigilance for signs of perforated NEC and may enable early intervention.
Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria?
Journal of Perinatology, 2007
In the last decade, it has become increasingly clear that necrotizing enterocolitis (NEC) is neither a uniform nor a well-defined disease entity. There are many factors that are forcing this unwelcome realization upon the neonatal and pediatric surgery communities. In the course of this manuscript we will review the history and the physical findings of the disparate etiologies of acquired
Necrotizing enterocolitis is associated with neonatal intestinal injury
Journal of Pediatric Surgery, 2011
PURPOSE: We hypothesized that a subset of premature newborns has subclinical, intestinal mucosal compromise that predisposes to the development of necrotizing enterocolitis (NEC) days or weeks later. METHODS: Fifty-five newborns of 23 to 36 weeks' gestational age were identified, and urine was collected over the first 90 hours of life. The urinary concentration of intestinal fatty acid binding protein (iFABP(u)), a sensitive marker for intestinal injury, was determined. The diagnosis of NEC was based upon clinical condition, pathology, and/or imaging findings. RESULTS: Neonatal iFABP(u) exceeded 800 pg/mL in 27 subjects, including 9 of 9 who subsequently developed stage 2 or 3 NEC. This degree of iFABP(u) elevation, but not asphyxia, was significantly associated with the development of NEC (P < .01). CONCLUSION: In this population of premature newborns, there was a substantial incidence of intestinal mucosal compromise. All infants who subsequently developed stage 2 or 3 NEC had an elevated iFABP(u). This finding suggests a model for the pathogenesis of some cases of NEC, whereby perinatal mucosal injury predisposes to further damage when feedings are initiated. In addition, neonatal iFABP(u) assessment may represent a tool to identify infants at the highest risk for NEC and allow for the institution of focused, preventive measures.
The ConNECtion Between Abdominal Signs and Necrotizing Enterocolitis in Infants 501 to 1500 g
Advances in Neonatal Care, 2017
BACKGROUND AND SIGNIFICANCE Necrotizing enterocolitis (NEC) of prematurity is a multifactorial disease, wherein the infant's immature gastrointestinal system, genetic influences, intestinal microbiota, microvascular tone, and inflammatory response interact to predispose the gut to injury. 1 It is a chief threat to the health of premature infants that can lead to long-term morbidity and developmental delay as well as consuming significant healthcare resources. Among very low birthweight (VLBW) infants, the overall incidence of NEC has been reported to vary based on birth weight, gestational age, and sample (see Table 1) with notable variation among centers. 2-8 Consequences of NEC can be severe including death, neurodevelopment impairment, 9 , 10 prolonged need for hospitalization and assisted nutrition, and long-term effects from malabsorption disorders like short gut syndrome. 11 When surgery is required, very strong evidence shows that VLBW survivors' risk for neurodevelopment impairment is double that of medical NEC survivors, 9 , 10 a consistent finding even when rigorous methodology is used and confounders are adjusted. 12 Long-term bowel problems and other functional impairments have also been reported. 13 Clearly, supporting early recognition and prompt treatment to avoid surgical NEC could improve outcomes for infants in the short-and long-term. Variations in NEC Incidence and Severity Medical NEC is managed with nonsurgical approaches (eg, antibiotics, bowel rest, serial radiography, and gastric decompression). Surgical NEC refers to those who require surgery (either
Journal of Pediatric Surgery, 2011
Purpose: The aim of this study was to compare the efficacy of serum amyloid A (SAA) with that of Creactive protein (CRP), and procalcitonin (PCT) in diagnosis and follow-up of necrotizing enterocolitis (NEC) in preterm infants. Methods: A total of 152 infants were enrolled into this observational study. The infants were classified into 3 groups: group 1 (58 infants with NEC and sepsis), group 2 (54 infants with only sepsis), and group 3 (40 infants with neither sepsis nor NEC, or control group). The data including whole blood count, CRP, PCT, SAA, and cultures that were obtained at diagnosis (0 hour), at 24 and 48 hours, and at 7 and 10 days were evaluated. Results: A total of 58 infants had a diagnosis of NEC. Mean CRP (7.4 ± 5.2 mg/dL) and SAA (46.2 ± 41.3 mg/dL) values of infants in group 1 at 0 hour were significantly higher than those in groups 2 and 3. Although the area under the curve of CRP was higher at 0 hour in infants with NEC, there were no significant differences between groups with respect to the areas under the curve of SAA, CRP, and PCT at all measurement times. Levels of SAA decreased earlier than CRP and PCT in the follow-up of NEC (mean SAA levels were 45.8 ± 45.2, 21.9 ± 16.6, 10.1 ± 8.3, and 7.9 ± 5.1 mg/dL at evaluation times, respectively). Levels of CRP and SAA of infants with NEC stages II and III were significantly higher than those with only sepsis and/or NEC stage I. Conclusions: Serum amyloid A, CRP, and PCT all are accurate and reliable markers in diagnosis of NEC, in addition to clinical and radiographic findings. Higher CRP and SAA levels might indicate advanced stage of NEC. Serial measurements of SAA, CRP, and PCT, either alone or in combination, can be used safely in the diagnosis and follow-up of NEC.
Scientific Reports, 2022
Necrotizing enterocolitis (NEC) is responsible for most morbidity and mortality in neonates. Early recognition of the clinical deterioration in newborns with NEC is essential to enhance the referral and management and potentially improve the outcomes. Here, we aimed to identify the prognostic factors and associate them with the clinical deterioration of preterm neonates with NEC. We analyzed the medical records of neonates with NEC admitted to our hospital from 2016 to 2021. We ascertained 214 neonates with NEC. The area under the receiver operating characteristic (ROC) curve and cutoff level of age at onset, C-reactive protein (CRP), leukocyte count, and platelet count for the clinical deterioration of preterm neonates with NEC was 0.644 and 10.5 days old, 0.694 and 4.5 mg/L, 0.513 and 12,200/mm 3 , and 0.418 and 79,500/mm 3 , respectively. Late-onset, history of blood transfusion, thrombocytopenia, and elevated CRP were significantly associated with the clinical deterioration of neonates with NEC (p = < 0.001, 0.017, 0.001, and < 0.001, respectively), while leukocytosis, gestational age, and birth weight were not (p = 0.073, 0.274, and 0.637, respectively). Multivariate analysis revealed that late-onset and elevated CRP were strongly associated with the clinical deterioration of neonates with NEC, with an odds ratio of 3.25 (95% CI = 1.49-7.09; p = 0.003) and 3.53 (95% CI = 1.57-7.95; p = 0.002), respectively. We reveal that late-onset and elevated CRP are the independent prognostic factor for the clinical deterioration of preterm neonates with NEC. Our findings suggest that we should closely monitor preterm neonates with NEC, particularly those with late-onset of the disease and those with an elevated CRP, to prevent further clinical deterioration and intervene earlier if necessary. Abbreviations PRC Packed red cell CRP C-reactive protein CI Confidence interval OR Odds ratio NEC Necrotizing enterocolitis Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency that affects preterm neonates 1,2. NEC is responsible for most perioperative fatalities in pediatric surgery, with a mortality rate of up to 19% 3. However, studies from developing countries on the clinical deterioration in preterm neonates are minimal. In addition, validated early indicators of clinical deterioration in preterm neonates with NEC are essential. Early predictors for surgery in premature neonates with NEC would help enhance referral and treatment pathways and potentially improve outcomes 4. Here, we aimed to identify the prognostic factors and associate them with the clinical deterioration of preterm neonates with NEC.
Time of Onset Necrotizing Enterocolitis: When We Should be Aware
Academia Letters, 2022
Necrotizing enterocolitis (NEC) is a gastrointestinal emergency commonly encountered in neonatal intensive care units, with an incidence of 1-5 per 1000 live births. Prematurity and formula feeding remain as major independent predictors for NEC, and in regards of that, NEC occurs in approximately 10% of preterm neonates [1-3]. Based on its management, NEC in premature infants is divided into two, namely medical and surgical NEC. Medical management of NEC (mNEC) includes stopping all enteral feedings, performing gastric decompression, and intravenous broad-spectrum antibiotics. On the other hand, in surgical NEC (sNEC) cases, estimated in 20-40% of cases, requiring surgical intervention, in which management geared to control sepsis and to remove the necrotic bowel and performs an ileostomy or anastomosis [1,4]. Necrotizing enterocolitis diagnosis is generally established using Bell's modification criteria, including systemic and laboratory, abdominal, and radiographic signs and parameters. Currently, pneumoperitoneum and worsening of clinical condition after optimum medical therapy, namely Bell stage III, are the most common indications for surgery [4,5]. However, Bell's criteria itself is still less sensitive and specific for early diagnosis and detection based on the clinical characteristics of medical and surgical NEC [6]. Early recognition of (NEC) requiring surgery and those who may recover with medical