title: Early detection of impending necrotizing enterocolitis with urinary intestinal fatty acid-binding protein.
abstract: 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.
  
  
  OBJECTIVE
  We sought to determine whether urinary intestinal fatty acid-binding protein (iFABPu) 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, iFABPu was determined using an ELISA, and was expressed in terms of its ratio to urinary creatinine (Cr), i.e. iFABPu/Cru. Receiver operating characteristic (ROC) curves were constructed to define the predictive value of iFABPu/Cru 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 iFABPu/Cru >10.2 pg/nmol predicted impending NEC with a sensitivity of 100% and a specificity of 95.6%. iFABPu/Cru did not predict NEC 2 days prior to the first sign of disease.
  
  
  CONCLUSIONS
  An elevated iFABPu was a sensitive and specific predictor of impending NEC 1 day prior to the first clinical manifestations. iFABPu screening might identify infants at a high risk and allow for the institution of measures that could ameliorate or prevent NEC.
authors.affiliation: Division of Pediatric Surgery, Loma Linda University School of Medicine, Loma Linda, Calif., USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Gollin
authors.forename: Derek
authors.initials: D
authors.lastname: Stadie
authors.forename: Jon
authors.initials: J
authors.lastname: Mayhew
authors.forename: Laurel
authors.initials: L
authors.lastname: Slater
authors.forename: Yayesh
authors.initials: Y
authors.lastname: Asmerom
authors.forename: Danilo
authors.initials: D
authors.lastname: Boskovic
authors.forename: Megan
authors.initials: M
authors.lastname: Holden
authors.forename: Danilyn
authors.initials: D
authors.lastname: Angeles
mesh_terms: D016022:Case-Control Studies; D042241:Early Diagnosis; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000652:urine; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000652:urine*; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000652:urine; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D050556:Fatty Acid-Binding Proteins