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Published on: June 24, 2020
Intestinal Inflammation is Significantly Associated With Length Faltering in Preterm Infants at Neonatal Intensive
Julie D Thai1, Sara Cherkerzian1,2, Evgenia J Filatava1
1Department of Pediatric Newborn Medicine.
Insights
Intestinal inflammation in preterm infants, measured by urinary intestinal fatty acid-binding protein (IFABP), is linked to poorer linear growth. Preventing this inflammation may improve growth outcomes for these vulnerable infants.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Infant Nutrition
Background:
- Preterm infants (<34 weeks' gestation) are at high risk for growth faltering.
- Intestinal inflammation is a common complication in preterm infants.
- Urinary intestinal fatty acid-binding protein (IFABP) and fecal calprotectin (FC) are biomarkers of intestinal injury and inflammation.
Purpose of the Study:
- To assess intestinal inflammatory markers (IFABP and FC) in relation to gestational age (GA) and postmenstrual age (PMA).
- To determine the association between intestinal inflammation and infant growth from birth to hospital discharge.
- To test the hypothesis that intestinal inflammation adversely affects preterm infant growth.
Main Methods:
- Repeated measures of IFABP and FC were collected from 72 hospitalized preterm infants.
- Weight and length z scores were calculated at birth and discharge using Fenton growth charts.
- Mixed linear and logistic regression models were used to assess associations between inflammatory markers and growth outcomes, adjusting for confounders.
Main Results:
- Mean IFABP levels were higher in infants born at earlier GA and decreased with increasing PMA; mean FC did not vary by GA or PMA.
- Higher mean IFABP and FC were associated with lower discharge growth z scores and increased likelihood of growth faltering.
- Specifically, mean IFABP was significantly associated with lower discharge length z scores and increased odds of length faltering.
Conclusions:
- Intestinal inflammation, indicated by IFABP, is associated with reduced linear growth and length faltering in preterm infants at discharge.
- Interventions aimed at preventing intestinal inflammation could potentially enhance linear growth in this population.
- IFABP serves as a valuable indicator of intestinal inflammation impacting growth in preterm infants.
Objective:
The aim of the study was to assess intestinal inflammatory measures, urinary intestinal fatty acid-binding protein (IFABP), and fecal calprotectin (FC) by gestational age (GA) and postmenstrual age (PMA) and determine the association between intestinal inflammation and growth in preterm infants from birth to hospital discharge. We hypothesized that intestinal inflammation is associated with adverse growth in preterm infants.
Methods:
We assayed repeated measures of IFABP and FC in 72 hospitalized preterm infants (<34 weeks' gestation). We calculated weight and length z scores at birth and discharge using the Fenton growth reference. Associations between mean IFABP or FC, growth z scores at discharge, and growth faltering (weight or length z score difference <-0.8 from birth to discharge) were assessed using mixed linear and logistic regression models, adjusted for intrafamilial correlation and potential confounders: GA, sex, birth z score, race/ethnicity, and maternal age.
Results:
Mean IFABP was greater among infants born at earlier GA and decreased with increasing PMA. Mean FC did not vary by GA or PMA. Higher mean IFABP and FC were associated with lower discharge growth z scores and greater likelihood of growth faltering significant only for mean IFABP and discharge length z score (β = -0.353, 95% confidence interval [CI]: -0.704 to -0.002) and mean IFABP and length faltering (odds ratio [OR] 1.99, P = 0.018).
Conclusions:
Intestinal inflammation, measured by IFABP, was associated with lower length z scores and length faltering at discharge. Interventions to prevent intestinal inflammation may improve linear growth among preterm infants.
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