Document Detail


Non-invasive markers for early diagnosis and determination of the severity of necrotizing enterocolitis.
MedLine Citation:
PMID:  20485148     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To improve diagnosis of necrotizing enterocolitis (NEC) by noninvasive markers representing gut wall integrity loss (I-FABP and claudin-3) and gut wall inflammation (calprotectin). Furthermore, the usefulness of I-FABP to predict NEC severity and to screen for NEC was evaluated. METHODS: Urinary I-FABP and claudin-3 concentrations and fecal calprotectin concentrations were measured in 35 consecutive neonates suspected of NEC at the moment of NEC suspicion. To investigate I-FABP as screening tool for NEC, daily urinary levels were determined in 6 neonates who developed NEC out of 226 neonates included before clinical suspicion of NEC. RESULTS: Of 35 neonates suspected of NEC, 14 developed NEC. Median I-FABP, claudin-3, and calprotectin levels were significantly higher in neonates with NEC than in neonates with other diagnoses. Cutoff values for I-FABP (2.20 pg/nmol creatinine), claudin-3 (800.8 INT), and calprotectin (286.2 microg/g feces) showed clinically relevant positive likelihood ratios (LRs) of 9.30, 3.74, 12.29, and negative LRs of 0.08, 0.36, 0.15, respectively. At suspicion of NEC, median urinary I-FABP levels of neonates with intestinal necrosis necessitating surgery or causing death were significantly higher than urinary I-FABP levels in conservatively treated neonates. Of the 226 neonates included before clinical suspicion of NEC, 6 developed NEC. In 4 of these 6 neonates I-FABP levels were not above the cutoff level to diagnose NEC before clinical suspicion. CONCLUSIONS: Urinary I-FABP levels are not suitable as screening tool for NEC before clinical suspicion. However, urinary I-FABP and claudin-3 and fecal calprotectin are promising diagnostic markers for NEC. Furthermore, urinary I-FABP might also be used to predict disease severity.
Authors:
Geertje Thuijls; Joep P M Derikx; Kim van Wijck; Luc J I Zimmermann; Pieter L Degraeuwe; Twan L Mulder; David C Van der Zee; Hens A A Brouwers; Bas H Verhoeven; L W Ernest van Heurn; Boris W Kramer; Wim A Buurman; Erik Heineman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  251     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-24     Completed Date:  2010-06-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1174-80     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Maastricht University Medical Centre, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / analysis
Enterocolitis, Necrotizing / diagnosis*,  pathology
Fatty Acid-Binding Proteins / urine*
Feces / chemistry
Humans
Infant, Newborn
Leukocyte L1 Antigen Complex / analysis*
Membrane Proteins / urine*
Severity of Illness Index
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Fatty Acid-Binding Proteins; 0/Leukocyte L1 Antigen Complex; 0/Membrane Proteins; 0/claudin 3

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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