title: Elevated fecal calprotectin levels during necrotizing enterocolitis are associated with activated neutrophils extruding neutrophil extracellular traps.
abstract: Neonates with necrotizing enterocolitis (NEC) have higher calprotectin levels in stool than do healthy neonates. However, it is not known whether high stool calprotectin at the onset of bowel symptoms identifies neonates who truly have NEC vs other bowel disorders.
  
  
  
  Neonates were eligible for this study when an x-ray was ordered to 'rule-out NEC'. Stool calprotectin was quantified at that time and in a follow-up stool. Each episode was later categorized as NEC or not NEC. The location of calprotectin in the bowel was determined by immunohistochemistry.
  
  
  
  Neonates with NEC had higher initial and follow-up stool calprotectin levels than did neonates without NEC. Calprotectin in bowel from neonates with NEC was within neutrophil extracellular traps (NETs).
  
  
  
  At the onset of signs concerning for NEC, fecal calprotectin is likely to be higher in neonates with NEC. Calprotectin in their stools is exported from neutrophils via NETs.
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: MacQueen
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.|Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.|Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Christensen
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.|Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Yost
authors.affiliation: Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.|Neonatal Intensive Care, McKay-Dee Hospital, Ogden, UT, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Lambert
authors.affiliation: Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.|Neonatal Intensive Care, McKay-Dee Hospital, Ogden, UT, USA.
authors.forename: V L
authors.initials: VL
authors.lastname: Baer
authors.affiliation: Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.|Neonatal Intensive Care, McKay-Dee Hospital, Ogden, UT, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sheffield
authors.affiliation: Mednax, Sunrise, FL, USA and Sacred Heart Women's and Children's Hospital, Pensacola, FL, USA.
authors.forename: P V
authors.initials: PV
authors.lastname: Gordon
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cody
authors.affiliation: Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.|Neonatal Intensive Care, Utah Valley Regional Medical Center, Provo, UT, USA.
authors.forename: E
authors.initials: E
authors.lastname: Gerday
authors.affiliation: ARUP Laboratories, Salt Lake City, UT, USA.|Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: R
authors.initials: R
authors.lastname: Schlaberg
authors.affiliation: ARUP Laboratories, Salt Lake City, UT, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lowe
authors.affiliation: Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.|Neonatal Intensive Care, Utah Valley Regional Medical Center, Provo, UT, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Shepherd
mesh_terms: D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D065206:Extracellular Traps / Q000378:metabolism; D005243:Feces / Q000737:chemistry*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000378:metabolism; D019102:Infant, Very Low Birth Weight; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis* / Q000378:metabolism; D009504:Neutrophils / Q000378:metabolism*; D010865:Pilot Projects; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex