Article ; Online: The relationship between reticulated platelets, intestinal alkaline phosphatase, and necrotizing enterocolitis.
2013 Volume 49, Issue 2, Page(s) 273–276
Abstract: Background: Necrotizing enterocolitis (NEC) affects up to 10% of extremely-low-birthweight infants, with a 30% mortality rate. Currently, no biomarker reliably facilitates early diagnosis. Since thrombocytopenia and bowel ischemia are consistent ... ...
| Abstract | Background: Necrotizing enterocolitis (NEC) affects up to 10% of extremely-low-birthweight infants, with a 30% mortality rate. Currently, no biomarker reliably facilitates early diagnosis. Since thrombocytopenia and bowel ischemia are consistent findings in advanced NEC, we prospectively investigated two potential biomarkers: reticulated platelets (RP) and intestinal alkaline phosphatase (iAP). Methods: Infants born ≤ 32 weeks and/or ≤ 1500 g were prospectively enrolled from 2009 to 2012. Starting within 72 hours of birth, 5 weekly whole blood specimens were collected to measure RP and serum iAP. Additional specimens were obtained at NEC onset (Bell stage II or III) and 24 hours later. Dichotomous cut-points were calculated for both biomarkers. Non-parametric (Mann-Whitney) and Chi-square tests were used to test differences between groups. Differences in Kaplan-Meier curves were examined by log-rank test. The Cox proportional hazards model estimated hazard ratios. Results: A total of 177 infants were enrolled in the study, 15 (8.5%) of which developed NEC (40% required surgery and 20% died). 14 (93%) NEC infants had "low" (≤ 2.3%) reticulated platelets, and 9 (60%) had "high" iAP (>0 U/L) in at least one sample before onset. Infants with "low" RP were significantly more likely to develop NEC [HR=11.0 (1.4-83); P=0.02]. Infants with "high" iAP were at increased risk for NEC, although not significant [HR=5.2 (0.7-42); P=0.12]. Median iAP levels were significantly higher at week 4 preceding the average time to NEC onset by one week (35.7 ± 17.3 days; P=0.02). Conclusion: Decreased RP serves as a sensitive marker for NEC onset, thereby enabling early preventative strategies. iAP overexpression may signal NEC development. |
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| MeSH term(s) | Alkaline Phosphatase/metabolism ; Biomarkers/metabolism ; Blood Platelets/pathology ; Enterocolitis, Necrotizing/metabolism ; Enterocolitis, Necrotizing/mortality ; Female ; Humans ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intestinal Mucosa/metabolism ; Male ; Prospective Studies | |||||
| Chemical Substances | Biomarkers ; Alkaline Phosphatase (EC 3.1.3.1) | |||||
| Language | English | |||||
| Publishing date | 2013-11-21 | |||||
| Publishing country | United States | |||||
| Document type | Journal Article | |||||
| ZDB-ID | 80165-3 | |||||
| ISSN | 1531-5037 ; 0022-3468 | |||||
| ISSN (online) | 1531-5037 | |||||
| ISSN | 0022-3468 | |||||
| DOI | 10.1016/j.jpedsurg.2013.11.037 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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