Fecal Calprotectin Concentrations in Premature Infants Have a Lower Limit and Show Postnatal and Gestational Age Dependence

Abstract

Background: 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. Objective: We aimed to provide developmental specific fCP data in premature infants and to analyze its value in detecting intestinal distress and episodes of NEC. Methods: Between April 2008 and December 2009, 1,899 fecal samples were obtained from 206 very low birth weight infants. Results: 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. Conclusions: 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.

Fecal S100A12

“…In line with previous studies on VLBW infants with NEC, we found that gestational and birth weight were significantly lower in VLBW infants with intestinal distress compared with the reference group (Table 1) (10,28). This points to the immaturity of the gastrointestinal tract of preterms, including the intestinal barrier function and innate immune defense (2)(3)(4)(5).…”

Feeding Intolerance in Preterm Neonates in Neonatal Intensive Care Unit, Padma General hospital, Dhaka

“…Study done by Zoppelli et al showed that mean GA was 28.5 weeks and birth weight 1057 gm. 9 In another study done by Albanna et al showed that they had a mean GA of 32 weeks, a mean birth weight of 1500 gm and a mean age at diagnosis of 9 days. 10 The study of Carroll et al 11 had a mean GA of 30 weeks and mean age at diagnosis of 12 days.…”

Relationships of Feeding and Mother's Own Milk with Fecal Calprotectin Levels in Preterm Infants

“…21 In contrast, Zoppelli et al examined 1,899 fecal samples from 206 VLBW infants and found that f-CP levels were dependent on gestational and postnatal age with particularly low levels in extremely premature infants. 13 Zoppelli et al measured over 28 days and had 66 cases of NEC or other gastrointestinal disease. They also excluded infants who had received antibiotic treatment after postnatal day 8.…”

“…8,[13][14][15] The current recommendation for feeding of preterm infants is to provide mother's own milk (MOM), fortified with protein, minerals, and vitamins for all infants weighing <1,500 g at birth.…”