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Longitudinal analysis of urinary I-FABP in extremely preterm infants that develop necrotizing enterocolitis
Jennifer B Fundora1, Darla R Shores2, Allen D Everett2
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jfundor1@jhmi.edu.
Insights
Urinary intestinal fatty acid binding protein (I-FABP) is elevated at necrotizing enterocolitis (NEC) diagnosis in preterm infants but falls post-NEC. However, I-FABP levels do not predict NEC-related gastrointestinal or neurodevelopmental outcomes.
Area of Science:
- Neonatal research
- Gastroenterology
- Biomarker discovery
Background:
- Intestinal fatty acid binding protein (I-FABP) is an intestinal epithelial protein.
- I-FABP is detectable in infants with necrotizing enterocolitis (NEC).
- The longitudinal behavior and predictive value of I-FABP in NEC are unknown.
Purpose of the Study:
- To compare urinary I-FABP levels in infants with and without NEC.
- To investigate the association of I-FABP levels with short-term and neurodevelopmental outcomes in NEC infants.
Main Methods:
- Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial.
- Serial urine I-FABP measurements using ELISA in matched infants (n=70).
- Non-parametric analysis to determine associations with outcomes.
Main Results:
- Infants with NEC showed higher I-FABP at diagnosis (11 vs 2.6 ng/ml) and lower levels post-NEC (1 vs 5 ng/ml) compared to controls.
- NEC diagnosis was associated with cholestasis, death, severe neurodevelopmental impairment, cerebral palsy, and lower motor scores.
- Diagnosis I-FABP levels were not associated with gastrointestinal or neurodevelopmental outcomes.
Conclusions:
- Urinary I-FABP is elevated at NEC diagnosis and decreases post-NEC in extremely preterm infants.
- I-FABP levels at NEC diagnosis do not predict adverse gastrointestinal or neurodevelopmental outcomes.
- Urinary I-FABP may aid in NEC diagnosis but not in predicting outcomes.
Background:
Intestinal fatty acid binding protein (I-FABP) is an intestinal epithelial protein detectable in infants with necrotizing enterocolitis (NEC). The longitudinal behavior of I-FABP following NEC or its association with gastrointestinal or neurodevelopmental outcomes is unknown.
Methods:
In this secondary analysis of the Preterm Erythropoietin Neuroprotection Trial, we compared infants with and without NEC. Urine I-FABP concentrations in matched infants (n = 70) were measured serially using ELISA and compared using paired analysis. In infants with NEC, the associations of I-FABP levels with short-term outcomes and neurodevelopmental outcomes at 22-26 months corrected age were determined using non-parametric analysis.
Results:
Infants with NEC were more likely to have cholestasis, death or severe neurodevelopmental impairment, cerebral palsy, and lower Bayley-III motor scores. Baseline urinary I-FABP levels were similar between groups. When compared to controls, infants with NEC had urinary I-FABP concentrations that were higher at diagnosis (median 11 vs 2.6 ng/ml, p = 0.006) and lower post-NEC (median 1 vs 5 ng/ml, p = 0.002). Diagnosis I-FABP levels were not associated with gastrointestinal or neurodevelopmental outcomes at 22-26 months corrected age.
Conclusions:
In extremely preterm infants, urinary I-FABP was elevated at NEC diagnosis and lower post-NEC compared to matched controls. I-FABP levels were not associated with adverse gastrointestinal or neurodevelopmental outcomes.
Impact:
Urinary intestinal fatty acid binding protein (I-FABP) levels are increased at diagnosis of NEC and fall to below baseline after NEC in extremely preterm infants. Urine I-FABP levels at NEC diagnosis are not associated with cholestasis, intestinal stricture or obstruction, need for additional intestinal surgery after NEC, or neurodevelopmental outcomes at 22-26 months corrected age. Urine I-FABP levels may be useful in the diagnosis of NEC. Diagnostic I-FABP levels do not predict short-term gastrointestinal or neurodevelopmental outcomes after NEC.
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