Serial fecal calprotectin in the prediction of necrotizing enterocolitis in preterm neonates.
PURPOSE
To investigate whether serial measurements of fecal calprotectin concentrations enable us to identify infants who will develop NEC prior to development of symptoms.


METHODS
Prospective matched case-control study including 100 high-risk neonates. High risk includes 1) gestational age (GA) ≤30 weeks, 2) birth-weight (BW) ≤1000 g, 3) GA 30-32 weeks and BW ≤1250 g, 4) born from a mother who received indomethacin for tocolysis. We matched every NEC subject with three controls for birth weight and gestational age. Fecal calprotectin was measured twice a week from day one until five weeks after birth or until NEC development. We analyzed differences in fecal calprotectin between NEC subjects and controls in the week preceding NEC onset and course of fecal calprotectin within subjects who developed NEC.


RESULTS
Of 100 included patients, ten (median GA 27.5 weeks [24.6-29.4], BW 1010 g [775-1630]) developed NEC. The median calprotectin concentration in all samples combined was 332 μg/g [<40-8230] μg/g feces. There were no differences between NEC subjects and controls, with a wide variation in both groups. In NEC subjects, there was no intraindividual rise in calprotectin before clinical symptoms occurred.


CONCLUSIONS
There are high concentrations and wide interindividual variations in calprotectin in preterm infants during the first weeks of life. Wide intraindividual variation further precludes the serial use of fecal calprotectin in the early detection or prediction of NEC in high risk infants.


LEVEL OF EVIDENCE
III.
['van Zoonen|Anne G J F|AGJF|', 'Hulzebos|Christian V|CV|', 'Muller Kobold|Anneke C|AC|', 'Kooi|Elisabeth M W|EMW|', 'Bos|Arend F|AF|', 'Hulscher|Jan B F|JBF|']
D015415:Biomarkers D001724:Birth Weight D016022:Case-Control Studies D020345:Enterocolitis, Necrotizing D005243:Feces D005260:Female D005865:Gestational Age D006801:Humans D007231:Infant, Newborn D007234:Infant, Premature D039841:Leukocyte L1 Antigen Complex D008297:Male D011446:Prospective Studies
Calprotectin Prediction Necrotizing enterocolitis Biomarkers