Urinary D-lactate excretion in infants with necrotizing enterocolitis

Urinary D-lactate excretion, expressed as the molar D-lactate/creatinine ratio, was measured serially in nine term and premature infants with necrotizing enterocolitis, 15 healthy term infants, and eight term and premature infants sick but without NEC. The mean (+/- SD) uDL/CR of the infants with NEC was 1.63 +/- 1.09, significantly greater than the mean uDL/CR of the healthy infants (0.16 +/- 0.04) or the sick infants without NEC (0.43 +/- 0.32). The uDL/CR of infants with NEC rose coincident with the onset of disease, reached peak values at an average of 5.8 days, and subsided to baseline levels on recovery. Seven of the nine infants with NEC reached or exceeded a peak uDL/CR of 1.47; no infant without NEC reached this ratio. We conclude that uDL/CR is increased in infants with NEC and demonstrates the increased enteric bacterial activity in this disease.