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Serum acute phase reactants in necrotizing enterocolitis
D Isaacs1, J North, D Lindsell
1Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford, UK.
Insights
Serum C-reactive protein (CRP) levels significantly increase in infants with necrotizing enterocolitis (NEC). Elevated CRP within 48 hours aids in diagnosing NEC, showing high sensitivity and specificity.
Area of Science:
- Biochemistry
- Neonatal Medicine
- Pediatric Surgery
Background:
- Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition in infants.
- Early diagnosis and management of NEC are crucial for improving outcomes.
- Biomarkers for NEC detection are actively sought.
Purpose of the Study:
- To evaluate the utility of serum acute phase reactants, specifically C-reactive protein (CRP) and orosomucoid, in diagnosing NEC.
- To determine the sensitivity and specificity of CRP in identifying definite NEC cases.
Main Methods:
- Prospective study comparing serum CRP and orosomucoid levels in infants with and without NEC.
- Analysis of CRP levels within 24-48 hours of presentation.
- Correlation of CRP levels with clinical outcomes, including surgical complications.
Main Results:
- Infants with definite NEC showed significantly elevated CRP and orosomucoid levels within 24-48 hours.
- A serum CRP threshold of >10 mg/l within 48 hours demonstrated 92% sensitivity and 81% specificity for definite NEC.
- Elevated CRP persisted in infants with late-onset sepsis, abscess, or stricture requiring surgery.
Conclusions:
- Serum acute phase reactants, particularly CRP, are valuable adjuncts for clinical assessment in suspected NEC.
- CRP can aid in early identification of NEC and potential complications.
- Monitoring CRP levels may assist in managing infants with suspected or confirmed NEC.
Abstract:
The serum acute phase reactants, C-reactive protein (CRP) and orosomucoid, rose significantly within 24 to 48 hours of presentation in infants with definite necrotizing enterocolitis (NEC) compared with the levels in infants with symptoms who tolerated early reintroduction of enteral feeds. A serum CRP value greater than 10 mg/l within 48 hours identified infants with definite NEC with a 92% sensitivity and an 81% specificity. Serum CRP values remained elevated at 7 to 10 days in 4 infants with late septicaemia and in 4 of 5 infants with abscess or early stricture requiring surgery. Serum acute phase reactants are a potentially valuable adjunct to clinical assessment in the management of infants with suspected NEC.