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Fecal calprotectin in very low birth weight infants
Stina Josefsson1, Susan K Bunn, Magnus Domellöf
1Department of Clinical Sciences, Paediatrics, Umeå University Hospital, Umeå, Sweden.
Insights
Fecal calprotectin (f-calprotectin) levels in very low birth weight (VLBW) infants can indicate severe intestinal disease. An f-calprotectin level exceeding 2000 microg/g is a useful, though not early, marker for conditions like necrotizing enterocolitis (NEC).
Area of Science:
- Neonatalogy
- Gastroenterology
- Biomarker Research
Background:
- Very low birth weight (VLBW) infants are susceptible to severe gastrointestinal conditions.
- Fecal calprotectin (f-calprotectin) is an inflammatory marker.
- Longitudinal monitoring of f-calprotectin in VLBW infants requires further investigation.
Purpose of the Study:
- To measure longitudinal f-calprotectin concentrations in VLBW infants.
- To identify changes in f-calprotectin associated with severe abdominal disease.
- To evaluate f-calprotectin as a potential biomarker for necrotizing enterocolitis (NEC) and other intestinal conditions.
Main Methods:
- The study enrolled 59 VLBW infants (<1500 g).
- F-calprotectin was measured in meconium and weekly from postnatal weeks 1-8.
- Seven infants developed severe abdominal disease (NEC or requiring laparotomy); f-calprotectin was sampled more frequently in these cases.
Main Results:
- In reference infants, median f-calprotectin in meconium was 332 microg/g and 253 microg/g in postmeconium samples.
- F-calprotectin levels correlated with delivery method, postnatal age, enteral feeds, antibiotics, and corticosteroids.
- In disease cases, f-calprotectin exceeded 2000 microg/g in 3 NEC cases and 1 perforation with inflammation; levels remained below 2000 microg/g in other cases.
Conclusions:
- F-calprotectin levels in VLBW infants are comparable to those in term and moderately preterm infants.
- An f-calprotectin level >2000 microg/g is a useful, but not an early, indicator of NEC and severe intestinal inflammation in VLBW infants.
Objectives:
To measure concentrations of fecal calprotectin (f-calprotectin) in infants with very low birth weight (VLBW; <1500 g) longitudinally and to describe changes in f-calprotectin in infants who develop severe abdominal disease.
Patients And Methods:
The study included 59 VLBW infants. Seven patients (disease group) developed severe abdominal disease defined as necrotizing enterocolitis (NEC) or a condition leading to laparotomy. The remainder (n = 52) were considered reference infants and had a mean (+/-SD) gestational age of 27.2 +/- 2.6 weeks and a birth weight of 939 +/- 273 g. F-calprotectin was analyzed in meconium and weekly during postnatal weeks 1 to 8. In disease cases, more frequent samples were analyzed around the time of abdominal disease diagnosis.
Results:
In reference infants the median (range) f-calprotectin level in meconium was 332 (12-9386) microg/g and correlated negatively to Apgar score. F-calprotectin in postmeconium samples was 253 (9-1867) microg/g and correlated positively to delivery by cesarean section, postnatal age, and volume of enteral feeds, and negatively to treatment with antibiotics and corticosteroids. In reference infants no postmeconium sample had f-calprotectin levels >2000 microg/g. In disease cases f-calprotectin was increased to >2000 microg/g in 3 cases of NEC and 1 case of covered perforation with microscopic bowel inflammation. In 1 case of NEC without microscopic bowel inflammation and 2 cases of focal intestinal perforation, f-calprotectin levels never exceeded 2000 microg/g.
Conclusions:
F-calprotectin concentrations in VLBW infants are similar to previously reported levels in healthy term and moderately preterm infants. An f-calprotectin level >2000 microg/g is a useful but not an early marker of NEC and other severe intestinal inflammatory conditions in VLBW infants.
