Necrotizing enterocolitis is associated with neonatal intestinal injury.
OBJECTIVE
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).


CONCLUSIONS
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.
Division of Pediatric Surgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
Kristyn
K
Mannoia
Danilo S
DS
Boskovic
Laurel
L
Slater
Megan S
MS
Plank
Danilyn M
DM
Angeles
Gerald
G
Gollin
D001238:Asphyxia Neonatorum / Q000150:complications; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000652:urine; D020345:Enterocolitis, Necrotizing / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development / Q000652:urine; D007413:Intestinal Mucosa / Q000378:metabolism / Q000503:physiopathology; D007422:Intestines / Q000098:blood supply; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000150:complications; D015427:Reperfusion Injury / Q000150:complications
D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; D003404:Creatinine