title: Blood Level of Inter-Alpha Inhibitor Proteins Distinguishes Necrotizing Enterocolitis From Spontaneous Intestinal Perforation.
abstract: To examine circulating levels of inter-alpha inhibitor protein (IaIp) in infants with necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), and matched controls to assess the diagnostic accuracy of IaIp to differentiate NEC from SIP and to compare receiver operating characteristics of IaIp for NEC with C-reactive protein (CRP).
  
  
  
  A prospective, nested case-control study of infants with feeding intolerance was carried out. Blood and clinical data were collected from 27 infants diagnosed with NEC or SIP and from 26 matched controls admitted to our unit. Infants with modified Bell criteria stage 2 or greater were included as NEC. Clinical, radiologic, and/or surgical findings were used to identify infants with SIP. Controls were matched for gestational age, postnatal age, sex, and birth weight.
  
  
  
  Mean ± SD IaIp blood levels were 147 ± 38 mg/L, 276 ± 67 mg/L, and 330 ± 100 mg/L in infants with NEC, SIP, and matched controls, respectively (P < .004 and P < .01). Receiver operating characteristics analysis to establish the predictive value of NEC demonstrated areas under curve of 0.98 and 0.63 for IaIp and CRP, respectively.
  
  
  
  IaIp levels were significantly decreased in infants with NEC compared with SIP and matched controls. The diagnostic accuracy of IaIp for NEC was superior to that of CRP.
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Department of Pediatrics, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI. Electronic address: Birju-Shah@ouhsc.edu.
authors.forename: Birju A
authors.initials: BA
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Alison
authors.initials: A
authors.lastname: Migliori
authors.affiliation: Department of Pediatrics, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Itsuka
authors.initials: I
authors.lastname: Kurihara
authors.affiliation: Department of Pediatrics, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Surendra
authors.initials: S
authors.lastname: Sharma
authors.affiliation: ProThera Biologics Inc., Providence, RI; Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Yow-Pin
authors.initials: YP
authors.lastname: Lim
authors.affiliation: Department of Pediatrics, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI.
authors.forename: James
authors.initials: J
authors.lastname: Padbury
mesh_terms: D000510:Alpha-Globulins / Q000032:analysis*; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D020345:Enterocolitis, Necrotizing / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies
chemical_list: D000510:Alpha-Globulins; C011877:inter-alpha-inhibitor; D002097:C-Reactive Protein
keywords: CRP; NEC; biomarker; diagnosis; intensive care unit; neonate; neurodevelopment; preterm