Acylcarnitine Profiles Reflect Metabolic Vulnerability for Necrotizing Enterocolitis in Newborns Born Premature.
To evaluate the association between newborn acylcarnitine profiles and the subsequent development of necrotizing enterocolitis (NEC) with the use of routinely collected newborn screening data in infants born preterm.



A retrospective cohort study was conducted with the use of discharge records for infants born preterm admitted to neonatal intensive care units in California from 2005 to 2009 who had linked state newborn screening results. A model-development cohort of 94 110 preterm births from 2005 to 2008 was used to develop a risk-stratification model that was then applied to a validation cohort of 22 992 births from 2009.



Fourteen acylcarnitine levels and acylcarnitine ratios were associated with increased risk of developing NEC. Each log unit increase in C5 and free carnitine /(C16 + 18:1) was associated with a 78% and a 76% increased risk for developing NEC, respectively (OR 1.78, 95% CI 1.53-2.02, and OR 1.76, 95% CI 1.51-2.06). Six acylcarnitine levels, along with birth weight and total parenteral nutrition, identified 89.8% of newborns with NEC in the model-development cohort (area under the curve 0.898, 95% CI 0.889-0.907) and 90.8% of the newborns with NEC in the validation cohort (area under the curve 0.908, 95% CI 0.901-0.930).



Abnormal fatty acid metabolism was associated with prematurity and the development of NEC. Metabolic profiling through newborn screening may serve as an objective biologic surrogate of risk for the development of disease and thus facilitate disease-prevention strategies.
Department of Surgery, Stanford University School of Medicine, Stanford, CA; Center for Fetal and Maternal Health, Lucile Packard Children's Hospital, Stanford, CA. Electronic address: Sylvester@Stanford.edu.
Karl G
KG
Sylvester
Department of Surgery, Stanford University School of Medicine, Stanford, CA; Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University/Stanford University School of Medicine, Stanford, CA.
Zachary J
ZJ
Kastenberg
Pediatric Surgery, Nationwide Children's Hospital, Ohio State University School of Medicine, Columbus, OH.
R Larry
RL
Moss
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Gregory M
GM
Enns
Department of Pathology, Stanford University School of Medicine, Stanford, CA.
Tina M
TM
Cowan
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Gary M
GM
Shaw
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
David K
DK
Stevenson
Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Tiffany J
TJ
Sinclair
Stanford Genome Technology Center, Stanford University, Palo Alto, CA.
Curt
C
Scharfe
Departments of Epidemiology and Pediatrics, College of Public Health and Carver College of Medicine, University of Iowa, Iowa, IA.
Kelli K
KK
Ryckman
Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California San Francisco School of Medicine, San Francisco, CA.
Laura L
LL
Jelliffe-Pawlowski
D015415:Biomarkers / Q000032:analysis; D002140:California; D002331:Carnitine / Q000031:analogs & derivatives* / Q000032:analysis / Q000097:blood; D015331:Cohort Studies; D016001:Confidence Intervals; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D015999:Multivariate Analysis; D015997:Neonatal Screening / Q000379:methods; D016017:Odds Ratio; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D035862:Vulnerable Populations
D015415:Biomarkers; C116917:acylcarnitine; D002331:Carnitine
fatty acids; metabolism; newborn screen; prematurity