title: Noninvasive measurement of intestinal epithelial damage at time of refeeding can predict clinical outcome after necrotizing enterocolitis.
abstract: BACKGROUND
  Reintroduction of enteral nutrition in neonates with necrotizing enterocolitis (NEC) should take place when the gut is ready for its normal function. Too early a start of oral feeding might lead to disease relapse, whereas prolonged discontinuation of enteral nutrition is associated with impaired gut function and parenteral nutrition-related complications. This study evaluated whether noninvasive urinary measurement of intestinal fatty acid binding protein (I-FABP) at the time of refeeding can predict clinical outcome in neonates with NEC.
  
  
  METHODS
  Urinary I-FABP concentrations were measured in 21 infants with NEC just before reintroducing enteral nutrition. Poor outcome was defined as unsuccessful reintroduction of enteral feeding (EF), (re)operation for NEC, or death related to NEC after reintroduction of EF.
  
  
  RESULTS
  Median urinary I-FABP levels in neonates with poor outcome (n = 5) were significantly higher as compared with I-FABP levels in neonates with good outcome (n = 16) (P < 0.01). A clinically significant cutoff value of 963 pg/ml was found to discriminate between infants with poor outcome and those with good outcome (sensitivity 80%, specificity 94%).
  
  
  CONCLUSIONS
  Noninvasive urinary I-FABP measurement at time of refeeding differentiates neonates with poor outcome from neonates with good outcome in NEC. Urinary I-FABP measurement may therefore be helpful in the timing of EF in neonates with NEC.
authors.affiliation: Department of Surgery, Maastricht University Medical Center, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, The Netherlands. k.reisinger@maastrichtuniversity.nl
authors.forename: Kostan W
authors.initials: KW
authors.lastname: Reisinger
authors.forename: Joep P M
authors.initials: JP
authors.lastname: Derikx
authors.forename: Geertje
authors.initials: G
authors.lastname: Thuijls
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
authors.forename: Hens A A
authors.initials: HA
authors.lastname: Brouwers
authors.forename: Annemarie A
authors.initials: AA
authors.lastname: van Bijnen
authors.forename: Tim G A M
authors.initials: TG
authors.lastname: Wolfs
authors.forename: L W Ernest
authors.initials: LW
authors.lastname: van Heurn
authors.forename: Wim A
authors.initials: WA
authors.lastname: Buurman
authors.forename: Boris W
authors.initials: BW
authors.lastname: Kramer
mesh_terms: D015415:Biomarkers / Q000652:urine; D004750:Enteral Nutrition / Q000009:adverse effects / Q000401:mortality; D020345:Enterocolitis, Necrotizing / Q000401:mortality / Q000473:pathology / Q000628:therapy* / Q000652:urine; D004847:Epithelial Cells / Q000378:metabolism* / Q000473:pathology; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000473:pathology; D008297:Male; D010289:Parenteral Nutrition, Total; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D016482:Urinalysis
chemical_list: D015415:Biomarkers; C493404:FABP2 protein, human; D050556:Fatty Acid-Binding Proteins