Necrotizing enterocolitis is associated with neonatal intestinal injury

Mannoia, Kristyn; Boskovic, Danilo S.; Slater, Laurel; Plank, Megan S.; Angeles, Danilyn M.; Gollin, Gerald

doi:10.1016/j.jpedsurg.2010.09.069

Cited by 39 publications

(28 citation statements)

References 32 publications

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“…There was one repetitive study [11]. Fourteen measured up to the criteria and were included [2,[5][6][7][8][12][13][14][15][16][17][18][19][20]. One hundred and thirty-five were excluded because they were animal studies, review articles, or irrelevant to the current study (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic Value of Intestinal Fatty-Acid-Binding Protein in Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis

Wang

Jiang

2016

Indian J Pediatr

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The present study was undertaken to evaluate the performance of intestinal fatty-acid-binding protein (i-FABP) in the diagnosis of newborn necrotizing enterocolitis (NEC) and prediction of surgical NEC. A comprehensive literature search was performed in PubMed and EMBASE to identify potential relevant studies. QUADAS-2 tool was used to assess the quality of the included studies. The sensitivity, specificity and other measurements of accuracy of i-FABP were pooled. Summary receiver operating characteristic curves (SROC) and area under the curve (AUC) were used to summarize overall diagnostic performance. After screening 150 titles and abstracts, followed by 32 full-text publications, 14 studies were included. The sample size, sensitivity, specificity, diagnostic odds ratio (DOR) and AUC were: plasma i-FABP 217, 0.64(95% CI 0.53 to 0.74), 0.91(95% CI 0.84 to 0.95), 14.22 (95%CI 6.42 to 31.52) and 0.84; urinary i-FABP 211, 0.64(95% CI 0.53 to 0.74), 0.73(95% CI 0.64 to 0.80), 6.35 (95%CI 3.17 to 12.72) and 0.81; urinary i-FABP/Cr 165, 0.78(95% CI 0.65 to 0.88), 0.75(95% CI 0.65 to 0.82), 6.35 (95%CI 3.17 to 12.72) and 0.81; plasma i-FABP for surgical NEC 45, 0.71(95% CI 0.51 to 0.87), 0.76(95% CI 0.50 to 0.93), 7.58 (95%CI 0.87 to 65.82) and 0.80. Plasma i-FABP is a promising biomarker in the diagnosis of NEC with high specificity and DOR; but its usefulness is limited because of medium sensitivity. The urinary i-FABP and urinary i-FABP/Cr add little value in the diagnosis. The findings were somewhat limited by the quality and small size of some of the studies included.

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Section: Resultsmentioning

confidence: 99%

“…Table 1 shows the characteristics of included studies with the optimal cut-off point values identified in the individual studies. They were conducted in Germany [6], USA [8,12,14,18,20], UK [13,19], Netherlands [5,7,16], Turkey [17], China [15] and Austria [2]. Eleven were finished in the past 5 y [2,5,7,[12][13][14][15][16][17][18][19].…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Value of Intestinal Fatty-Acid-Binding Protein in Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis

Wang

Jiang

2016

Indian J Pediatr

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“…It is appealing to investigate whether (extremely) premature neonates with high I-FABP levels shortly after birth are at increased risk for developing intestinal disorders or whether these high levels normalize without an increased risk. I-FABP as a screening tool for NEC has been investigated before (27). Urinary I-FABP levels in the first 90 h after birth were measured in 55 preterm neonates.…”

Section: Discussionmentioning

confidence: 99%

Intestinal fatty acid–binding protein: a possible marker for gut maturation

et al. 2014

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Background: Gut immaturity is linked with postnatal intestinal disorders. However, biomarkers to assess the intestinal developmental stage around birth are lacking. The aim of this study was to gain more insight on intestinal fatty acid-binding protein (I-FABP) as an indicator of gut maturity. Methods: Antenatal I-FABP distribution and release was investigated in extremely premature, moderately premature, and term lambs, and these findings were verified in human urinary samples. Ileal I-FABP distribution was confirmed in autopsy material within 24 h postnatally. results: Median (range) serum I-FABP levels were lower in extremely premature lambs compared with moderately premature lambs (156 (50.0-427) vs. 385 (100-1,387) pg/ml; P = 0.02). Contrarily, median early postnatal urine I-FABP levels in human infants were higher in extremely premature compared with moderately premature and term neonates (1,219 (203-15,044) vs. 256 (50-1,453) and 328 (96-1,749) pg/ml; P = 0.008 and P = 0.04, respectively). I-FABP expression was most prominent in nonvacuolated enterocytes and increased with rising gestational age (GA) in ovine and human tissue samples. The epithelial distribution pattern changed from a phenotype displaying I-FABP-positive enterocytes merely in the crypts early in gestation into a phenotype with I-FABP expressing cells exclusively present in the villus tips at term in ovine and human tissue. conclusion: In this ovine and human study, increasing GA is accompanied by an increase in I-FABP tissue content. Cord I-FABP levels correlate with gestation in ovine fetuses, identifying I-FABP as a marker for gut maturation. Raised postnatal urine I-FABP levels in preterm human infants may indicate intestinal injury and/or inflammation in utero.

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“…iFABP has been shown to be a sensitive marker for mucosal injury due caused by ischemia/reperfusion [12], low-flow [13] and NEC [14]. We recently found that iFABP u was elevated during the first days of life in all infants who subsequently developed NEC [9]. This indicated that perinatal mucosal injury might be an important component in the pathogenesis of NEC that manifests days or even weeks later.…”

Section: Discussionmentioning

confidence: 99%

“…We demonstrated that levels of urinary intestinal fatty acid-binding protein (iFABP u ), a sensitive and specific marker for intestinal mucosal injury, were elevated during the first 4 days of life in all infants who went on to develop NEC days or even weeks later [9]. This finding indicated that perinatal intestinal mucosal injury might be a necessary step in the pathophysiology of NEC.…”

Section: Introductionmentioning

confidence: 99%

Early Detection of Impending Necrotizing Enterocolitis with Urinary Intestinal Fatty Acid-Binding Protein

Gollin¹,

Stadie²,

Mayhew³

et al. 2014

Neonatology

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Background: Necrotizing enterocolitis (NEC) is diagnosed after the development of feeding intolerance and characteristic physical and imaging findings. Earlier detection of a subclinical prodrome might allow for the institution of measures that could prevent or attenuate the severity of the disease. Objectives: We sought to determine whether urinary intestinal fatty acid-binding protein (iFABP_u) might be elevated prior to the first clinical manifestations of NEC. Methods: Urine was collected daily from 62 infants of a gestational age of 24-28 weeks. Based on clinical, imaging and operative findings, subjects were determined to have Bell stage 2 or 3 NEC. In all the subjects with NEC and in 21 age-matched controls, iFABP_u was determined using an ELISA, and was expressed in terms of its ratio to urinary creatinine (Cr), i.e. iFABP_u/Cr_u. Receiver operating characteristic (ROC) curves were constructed to define the predictive value of iFABP_u/Cr_u for impending NEC in the days prior to the first clinical manifestations. Results: Five subjects developed NEC (stage 2: n = 3 and stage 3: n = 2). The day before the first clinical manifestation of NEC, a ROC curve showed that an iFABP_u/Cr_u >10.2 pg/nmol predicted impending NEC with a sensitivity of 100% and a specificity of 95.6%. iFABP_u/Cr_u did not predict NEC 2 days prior to the first sign of disease. Conclusions: An elevated iFABP_u was a sensitive and specific predictor of impending NEC 1 day prior to the first clinical manifestations. iFABP_u screening might identify infants at a high risk and allow for the institution of measures that could ameliorate or prevent NEC.

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Necrotizing enterocolitis is associated with neonatal intestinal injury

Cited by 39 publications

References 32 publications

Diagnostic Value of Intestinal Fatty-Acid-Binding Protein in Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis

Diagnostic Value of Intestinal Fatty-Acid-Binding Protein in Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis

Intestinal fatty acid–binding protein: a possible marker for gut maturation

Early Detection of Impending Necrotizing Enterocolitis with Urinary Intestinal Fatty Acid-Binding Protein

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