The Risk Factors Of Neonatal Necrotizing Enterocolitis And The Clinical Value Of Serum Intestinal Fatty Acid Binding Protein Level In Early Diagnosis On The Diseases

Background:Necrotizing enterocolitis(NEC), a major cause of death in preterm infants, remains one of the major unsolved problems of perinatal care. To date the etiology and pathogenesis of NEC remain unclear. Clinical progression of NEC turn out to be insidious unexpected and catastrophic. It often accompany with nonspecific clinical signs at the early stage. Both the Plain abdominal radiography and Conventional Blood Laboratory Tests are lack of specificity. In this case, there is no any effective managements for NEC prevention up to now. Therefore, by analyzing the characteristics and risk factors of NEC, our study aim to provide the theoretical based disease control in NEC high-risk infants for clinical used. In addition, some studies demonstrated that intestinal mucosal injury is the first critical element when NEC occurred and developed as well. Intestinal fat binding protein(I- FABP) mainly distributed in the top of the small intestinal mucosa villus cells. It has been reported that serum I-FAB with high organ specificity become a useful marker for early diagnosis of intestinal ischemia and necrosis. Objective:1. To analyse the clinical characteristics and risk factors of NEC.2. To explore the value of serum I-FABP for early diagnosis and the prediction ofsevere necrotizing enterocolitis. Methods:1.This study was conducted between May 1, 2014 and February 31, 2014. 34 hospitalized infants with NEC were included treat as case group. The other 34 non-NEC weight-matched infants with same gender, corrected gestational age are assigned as control group. Careful Clinical observation and record were carried out during the course of disease in the case group. Clinic date were check again when the NEC infants leave hospital. Then we summarized the clinic feature of the onset of disease. Univariate analysis and logistic regression were used to analyze the 21 risk factors between two groups.2.This study was conducted between May 1, 2014 and February 31, 2014. 34 hospitalized infants with NEC were included in this study as the case group. NEC diagnosis are based on the bell staging criteria. These infants were divided into two groups according to their final diagnoses: mild NEC group(NECⅠn=17) and severe NEC group(NECⅡn=7;NECⅢn=17). 34 non-NEC weight-matched infants with the same gender, corrected gestational age are assigned as control group. Two blood samples were obtained from the case group at the early stage of disease and disease remission. The other one blood sample was taken from the controls. The enzyme linked immunosorbent assay(ELISA) was subsequently used to compare the serum I-FABP level in each group, which contribute to calculate sensitivity and specificity for the diagnosis of NEC. Receiver operating characteristics(ROC) curves were drawn to in order to find out the cutoff points of serum I-FABP at diagnosis. Results:1. There is a negative correlation between age at the time of NEC diagnosis and gestational age as well as body weight. According to the frequency of occurrence, NEC common systemic symptoms were: apnea, listlessness, poor response, metabolic acidosis, temperature instability, neutropenia, shock, DIC. Abdominal distension is the most common gastrointestinal presentation, followed by abdominal distension, gastric retention, decreased bowel sounds, abdominal tenderness, absent bowel sounds naked bloody stools, bile stomach contents, upper gastrointestinal bleeding, vomiting. The Plain abdominal radiography and Conventional Blood Laboratory Tests are limited during the diagnosis of NEC.2. The below symptoms such as NRDS, heart failure, low T3 syndrome, mechanical ventilation are able to increase the risk of NEC occured. Additionally, Sepsis is an independent risk factor which associated with NEC.3. The mean serum I-FABP concentrations at the beginning of disease are 3296.34pg/ml(1791.60,3833.07), 17862.30pg/ml(13580.9,25291.5)in mild NEC group and severe NEC group, respectively, and all are significantly higher than those at control group which is 1485.49pg/ml(948.67,2438.42)(P=0.000).4.The mean serum I-FABP concentrations of disease remission are 9928.99pg/ml(674.63,1084.40)、1012.19pg/ml(935.12,2702.24),in mild NEC group and severe NEC group, respectively. There is not any significantly different between these two groups(P=0.225). However, the I-FABP concentrations are remarkable lower than the Serum which collected at the beginning of disease.(P=0.000、P=0.008).5. Serum I-FABP concentrations at the beginning of disease were used for drawing the ROC curve. The cutoff points, sensitivity and specificity of serum I-FABP in diagnosis of NEC were 2857.14 pg/ml(about 2.875 ng/ml), 79.4%, 85.3%, respectively. The correct diagnosis index, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value were 64.7%, 5.4, 0.24, 84.4%, 80.6%, respectively. Conclusions:The pathogenesis of NEC is influence by its multifactorial reasons. Early clinical manifestations and diagnostic methods lack of high specificity. To prevent the incidence of NEC, we should observe the patients’ conditions carefully, control infection immediately after enteral nutrition of the NEC high risks neonatal, especially low birth weight preterm infant. Serum I-FABP is one of the useful plasma marker for early diagnosis and prediction of disease severity in NEC.