Article

Fecal calprotectin concentrations in premature infants have a lower limit and show postnatal and gestational age dependence.

HELIOS Children's Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany.
Neonatology (Impact Factor: 2.57). 05/2012; 102(1):68-74. DOI: 10.1159/000337841
Source: PubMed

ABSTRACT There is a need for reliable diagnostic biomarkers in necrotizing enterocolitis (NEC). Whereas fecal calprotectin (fCP) has been reported to have insufficient sensitivity and specificity, no previous study has stratified for gestational and postnatal age.
We aimed to provide developmental specific fCP data in premature infants and to analyze its value in detecting intestinal distress and episodes of NEC.
Between April 2008 and December 2009, 1,899 fecal samples were obtained from 206 very low birth weight infants.
Mean gestational age (GA) was 28.5 weeks and birth weight 1,057 g. 19 (9.2%) patients developed NEC stage II+, of whom 5 had fulminant NEC with unusually low fCP concentrations in meconium and afterwards. fCP levels showed significant gestational and postnatal age dependent dynamics with particularly low levels in extremely premature infants. In infants with a GA <26 + 1 weeks using GA-adapted reference values, the sensitivity for discriminating moderate NEC from healthy infants and infants with intestinal distress was 0.89 for a cut-off of 180 and 210 µg/g, respectively, at onset of symptoms. Specificity was 0.96 and 0.84. Fulminant NEC was characterized by unusually low fCP concentrations with a cut-off of <24 µg/g having a sensitivity of 0.84 and a specificity of 0.72 for identifying those cases.
fCP levels depend on gestational and postnatal age and in contrast to adults, there is a lower limit in premature infants. Taking these observations into account when defining reference values and interpreting fCP data in the clinical context, fCP can be a useful marker in identifying premature infants with gastrointestinal distress and NEC in particular.

0 Bookmarks
 · 
49 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Calprotectin is a 36 kDa protein present in the cytoplasm of the neutrophil has antimicrobial and apoptosis inducing activities. In vitro studies have shown that calprotectin inhibits the growth of various microorganisms. Necrotizing enterocolitis (NEC) remains one of the leading causes of morbidity and mortality in neonatal intensive care units (NICU), affecting up to 5% of premature infants. Fecal calprotectin is resistant to degradation and has been proposed as a useful marker of gastrointestinal inflammation. The objective of the present study is to evaluate fecal calprotectin concentrations in NEC. Fifteen neonates with a clinical diagnosis of NEC were studied; they admitted at NICU of Zagazig University Hospital. In addition, 20 age sex matched neonates fed all caloric requirement served as the control group. All neonates were subjected to history taking, clinical examination, laboratory investigations (complete blood count, C-reactive protein) and determination of stool calprotectin. There was a highly significant increase in fecal calprotectin in patients than control and there was a highly significant increase in its fecal level in died patients than living one. Also significant increase in fecal calprotectin level with increasing severity of NEC. Fecal calprotectin measurements could be a valuable tool for the investigation of preterm and full term infants suspected of having NEC.
    Journal of clinical neonatology. 01/2014; 3(1):16-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine levels of antimicrobial polypeptides (AMP) in cord blood of term and preterm neonates and to investigate influencing factors. In a single centre study n=139 preterm infants and n=36 term infants were included. AMP levels were analysed in supernatants of whole cord blood cultures with a standardized concentration of 5 x 10(6) white blood cells/mL via enzyme-linked-immunosorbent assay (ELISA). Lactoferrin, human neutrophil peptides (HNP) 1-3 and bacterial permeability increasing protein (BPI) expression in cord blood of preterm infants were influenced by the cause of preterm delivery, i.e. increased levels in infants with clinical amniotic infection. AMP levels also weakly correlated with white blood cell and neutrophil count at birth. In the whole cohort, no association between gestational age or birth weight with AMP levels was found. In the subgroup of infants without clinical amniotic infection (n=77 preterm infants, n=36 healthy term infants), we noted a weak correlation between gestational age and lactoferrin, calprotectin and HNP1-3 levels. In addition to that, we observed higher levels of lactoferrin and HNP1-3 in large-for-gestational-age infants. Our study confirms that several factors influence cord blood AMP levels which underlines the difficulties of using AMP levels as biomarkers of immunological response. This article is protected by copyright. All rights reserved.
    Acta Paediatrica 01/2014; · 1.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Necrotizing enterocolitis (NEC) remains a very devastating problem within the very low birth weight neonatal population. Several experimental therapies are being tested in animal models and soon may be ready for human trials. Despite this progress, we currently have no way to identify infants who would be optimal targets for therapy. Specifically, we are unable to predict which infants will progress to the more severe Bell's stage of disease that may necessitate surgery. Ideally, an algorithm could be constructed that would encompass multiple neonatal and maternal risk factors as well as potential biologic markers of disease so that these infants could be identified in a more timely fashion. This review summarizes the known risk factors and biomarkers of disease in hopes of stimulating clinical research to identify such an "early warning" NEC algorithm.
    Journal of clinical neonatology. 01/2014; 3(1):1-9.