Hexosaminidase: A biochemical marker for necrotizlng enterocolitls in the preterm infant (original) (raw)

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.

The Role of Oxidative Stress in the Necrotizing Enterocolitis of Preterm

Journal of the Siena Academy of Sciences, 2012

Introduction: Oxidative stress (OS) is strongly envolved in the pathogenesis of many preterm newborn diseases; this is due to the low efficiency of natural antioxidant systems unable to counteract the harmful effects of free radicals (FRs). Necrotizing Enterocolitis (NEC) is a multifactorial disease and it is part of the so called "free radicals related diseases". Hypoxic-ischaemic events and inflammation, involved in NEC pathogenesis, are responsible of the overproduction of free radicals (FRs), generating OS. Aim: To test the hypotesis that OS marker levels in cord blood may predict the onset of NEC in high risk infants. Materials and methods: 91 preterm newborns of gestational age between 24 and 33 weeks and birth weight between 460 and 2540 grams were consecutively recruited in two italian neonatal intensive care units. Markers of potential oxidative stress risk, Non Protein Bound Iron (NPBI), and free radicals damage, Advanced Oxidation Protein Products (AOPP) and Total Hydroperoxide (TH), were measured in the cord blood. Associations between NEC and OS markers have been checked through inferential analysis (univariate logistic regression). Results: Out of 91 preterm babies, 8 developed NEC. Babies with NEC had a birth weight (BW) and a gestational age (GA) significantly lower than healthy babies (BW=1100,52 ± 444,30 vs 1320,53 ± 462,09; GA=29,02 ± 2,09 vs 30,14 ± 2,33, respectively. p<0.005). Cord blood levels of TH and NPBI were higher in babies with NEC than in babies without, but not significantly. AOPP cord blood levels were significantly higher in babies with NEC than the babies without (AOPP=29,15 ± 20,02 vs 16,72 ± 7,34; p<0.05). AOPP demonstrated a significant value for the identification of the risk of NEC (OR=1.13, CI 95%= 1.001-1.282). Conclusions: OS is strongly associated with NEC. The determination of biochemical OS markers in cord blood can be useful in identifying babies at high risk to develop NEC and in devising new strategies to bring consistent benefits to premature babies.

Hypoxic-ischemic enterocolitis: a proposal of a new terminology for early NEC or NEC-like disease in preterm infants, a single-center prospective observational study

European Journal of Pediatrics, 2019

We aimed to investigate the role of hypoxia-ischemia in the pathophysiology of early NEC/NEC like disease (ENEC) and classic NEC/NEC like disease (CNEC) in preterm infants. In this pilot study, preterm infants who developed the clinical symptoms and signs of NEC/NEC like disease were divided into two groups as early (≤ 7 days, ENEC) or late (> 7 days, CNEC) groups. Beside clinical variables, serum L-lactate, endothelin-1 (ET-1), platelet activating factor (PAF), and intestinal fatty acid binding protein (I-FABP) levels were measured from umbilical/peripheric venous blood in the first hour of life and during the clinical presentation in all groups. A total of 86 preterm infants were enrolled in the study. In the ENEC group, the incidences of fetal umbilical artery Doppler velocimetry abnormalities, IUGR, and delayed passage of first meconium were higher. In addition, mean levels of L-lactate, ET-1, PAF, and I-FABP were higher in the first hour of life. Conclusion: Our study firstly showed that the dominant pathophysiological factor of ENEC is prenatal hypoxic-ischemic event where intestinal injury and inflammation begin in-utero and become clinically apparent in the first week of life. Therefore, we propose a new term "Hypoxic-Ischemic Enterocolitis (HIEnt)" for the definition of ENEC in preterm infants with prenatal hemodynamic disturbances and IUGR. This new sight can provide individualized preventive and therapeutic strategies for preterm infants. What is Known: • The pathophysiology of early necrotizing enterocolitis (NEC) or NEC-like disease which is seen in the first week of life seems different than classic necrotizing enterocolitis (CNEC) which is always seen after the first week of life. What is New: • This study suggests that perinatal hypoxic-ischemic process with inflammation is the point of origin of fetal intestinal injury leading to ENEC. • We propose a new term "Hypoxic-Ischemic Enterocolitis (HIEnt)" for the definition and differentiation of this unique clinical entity.

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.

Non-Invasive Markers for Early Diagnosis and Determination of the Severity of Necrotizing Enterocolitis

Annals of Surgery, 2010

Necrotizing enterocolitis (NEC) remains one of the most frequent gastrointestinal diseases in the neonatal intensive care unit, with a continuing unacceptable high mortality and morbidity rates. Up to 20% to 40% of infants with NEC will need surgical intervention at some point. Although the exact pathophysiology is not yet elucidated, prematurity, use of formula feeding, and an altered intestinal microbiota are supposed to induce an inflammatory response of the immature intestine. The clinical picture of NEC has been well described. However, an early diagnosis and differentiation against sepsis is challenging. Besides, it is difficult to timely identify NEC cases that will deteriorate and need surgical intervention. This may interfere with the most optimal treatment of infants with NEC. In this review, we discuss the pathogenesis, diagnosis, and treatment of NEC with a focus on the role of microbiota in the development of NEC. An overview of different clinical prediction models and biomarkers is given. Some of these are promising tools for accurate diagnosis of NEC and selection of appropriate therapy. (Inflamm Bowel Dis 2015;21:436-444)

Frequency of Necrotizing Enterocolitis in Preterm Neonates and Their Outcome During Hospital Stay

2017

Background: Neonatal necrotizing enterocolitis [NEC], characterized by intestinal necrosis and pneumatosis intestinal, is the most common gastrointestinal emergency in the premature newborns [1]. The disease has an incidence rate of 2 to 5% in premature infants. The incidence rate increases to 13% in those weighing 1,500 gram at birth. NEC has a mortality rate of 10 to 55%. Objective: To determine the frequency of necrotizing enterocolitis in preterm neonates along with their outcome during stay in hospital. Methods: All premature newborn with morbidity admitted at Neonatal Intensive Care Unit [NICU] the Children Hospital, PIMS, Islamabad were screened for enrolment. A total of 156 premature newborn who fulfilled the inclusion criteria were enrolled in the current study. The duration of study was 6 months. At the time of enrolment, demographic characteristics of all the enrolled babies were obtained and noted on the proforma specially designed for the study. Delivery complications, ...

Current status of laboratory and imaging diagnosis of neonatal necrotizing enterocolitis

Italian Journal of Pediatrics, 2018

Necrotizing enterocolitis continues to be a devastating disease process for very low birth weight infants in Neonatal Intensive Care Units. The aetiology and pathogenesis of necrotizing enterocolitis are not definitively understood. It is known that necrotizing enterocolitis is secondary to a complex interaction of multiple factors that results in mucosal damage, which leads to intestinal ischemia and necrosis. Advances in neonatal care, including resuscitation and ventilation support technology, have seen increased survival rates among premature neonates and a concomitant detection in the incidence of this intestinal disease. Diagnosis can be difficult, and identifying infants at the onset of disease remains a challenge. Early diagnosis, which relies on imaging findings, and initiation of prompt therapy are essential to limit morbidity and mortality. Moreover, early management is critical and life-saving. This review summarizes what is known on the laboratory and instrumental diagnostic strategies needed to improve neonatal outcomes and, possibily, to prevent the onset of an overt necrotizing enterocolitis.

Early Postnatal Comprehensive Biomarkers Cannot Identify Extremely Preterm Infants at Risk of Developing Necrotizing Enterocolitis

Frontiers in Pediatrics, 2021

Background: Necrotizing enterocolitis (NEC) is a fatal disease where current diagnostic tools are insufficient for preventing NEC. Early predictive biomarkers could be beneficial in identifying infants at high risk of developing NEC.Objective: To explore early biomarkers for predicting NEC in extremely preterm infants (EPIs).Methods: Blood samples were collected on day 2 (median 1.7; range 1.5–2.0) from 40 EPI (median 25 gestational weeks; range 22–27): 11 developed NEC and 29 did not (controls). In each infant, 189 inflammatory, oncological, and vascular proteomic biomarkers were quantified through Proximity Extension Assay. Biomarker expression and clinical data were compared between the NEC group and Controls. Based on biomarker differences, controls were sorted automatically into three subgroups (1, 2, and 3) by a two-dimensional hierarchical clustering analysis.Results: None of the biomarkers differed in expression between all controls and the NEC group. Two biomarkers were hig...