Association of cord blood digitalis-like factor and necrotizing enterocolitis.
OBJECTIVE
Endogenous digoxin-like factor (EDLF) has been linked to vasoconstriction, altered membrane transport, and apoptosis. Our objective was to determine whether increased EDLF in the cord sera of preterm infants was associated with an increased incidence of necrotizing enterocolitis (NEC).


METHODS
Cord sera from pregnant women enrolled in a randomized trial of MgSO4 for fetal neuroprotection were analyzed for EDLF using a red cell Rb(+) uptake assay in which the inhibition of sodium pump-mediated Rb(+) transport was used as a functional assay of EDLF. Specimens were assayed blinded to neonatal outcome. Cases (NEC, n = 25) and controls (neonates not developing stage 2 or 3 NEC, n = 24) were matched by study center and gestational age. None of the women had preeclampsia. Cases and controls were compared using the Wilcoxon test for continuous and the Fisher exact test for categorical variables. A conditional logistic regression analysis was used to assess the odds of case vs control by EDLF level.


RESULTS
Cases and controls were not significantly different for gestational age, race, maternal steroid use, premature rupture of membranes, or MgSO4 treatment. In logistic models adjusted for treatment group, race, premature rupture of membranes, and gestational age, cord sera EDLF was significantly associated with development of NEC (P = .023).


CONCLUSIONS
These data demonstrated an association between cord sera EDLF and NEC.
Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT. Electronic address: swgraves@chem.byu.edu.
Steven W
SW
Graves
Departments of Obstetrics and Gynecology, Utah Health Science Center, Salt Lake City, UT.
Michael S
MS
Esplin
Biostatistics Center, George Washington University, Washington, DC.
Paula
P
McGee
University of Alabama at Birmingham School of Medicine, Birmingham, AL.
Dwight J
DJ
Rouse
University of Texas Southwestern Medical Center, Dallas, TX.
Kenneth J
KJ
Leveno
Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, and University of Tennessee, Memphis, TN.
Brian M
BM
Mercer
The Ohio State University College of Medicine, Columbus, OH.
Jay D
JD
Iams
Jefferson Medical College, Thomas Jefferson University, and Drexel University College of Medicine, Philadelphia, PA.
Ronald J
RJ
Wapner
Wayne State University School of Medicine, Detroit, MI.
Yoram
Y
Sorokin
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
John M
JM
Thorp
University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
Susan M
SM
Ramin
College of Physicians and Surgeons, Columbia University, New York, NY.
Fergal D
FD
Malone
Miller School of Medicine, University of Miami, Miami, FL.
Mary J
MJ
O'Sullivan
Feinberg School of Medicine, Northwestern University, Chicago, IL.
Alan M
AM
Peaceman
University of Texas Medical Branch, Galveston, TX.
Gary D V
GDV
Hankins
University of Texas at San Antonio School of Medicine, San Antonio, TX.
Donald J
DJ
Dudley
University of Pittsburgh School of Medicine, Pittsburgh, PA.
Steven N
SN
Caritis
D002298:Cardenolides / Q000032:analysis*; D016022:Case-Control Studies; D020345:Enterocolitis, Necrotizing / Q000097:blood*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007235:Infant, Premature, Diseases / Q000097:blood*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D012503:Saponins / Q000032:analysis*; D012720:Severity of Illness Index
D002298:Cardenolides; D012503:Saponins; C034504:digoxin-like factors
cord blood; digitalis-like factor; necrotizing enterocolitis; pregnancy; sodium pump