C-Reactive Protein in the Diagnosis, Management, and Prognosis of Neonatal Necrotizing Enterocolitis

Abstract Purpose The role of hypoalbuminemia and raised C-reactive protein (CRP) levels in predicting critical prognosis has been described extensively in adult literature. However, there are limited studies in pediatrics, particularly neonates. The CRP/albumin (CRP/ALB) ratio is often associated with higher mortality, organ failure and prolonged hospital stay. We hypothesized that the serum CRP/ALB ratio has a prognostic value in predicting surgery and mortality in neonates with necrotizing enterocolitis (NEC). Methods Retrospective review of all neonates with clinical and radiological evidence of non-perforated NEC that were treated in a tertiary-level referral hospital between 2009 and 2018. General patient demographics, laboratory parameters and outcomes were recorded. Receiver operating characteristics analysis was performed to evaluated optimal cut-offs and area under the curve (AUC) with 95% confidence intervals (CI). Results A total of 191 neonates were identified. Of these, 103 (53.9%) were born at ≤ 28 weeks of gestation and 101 (52.9%) had a birth weight of ≤ 1000 g. Eighty-four (44.0%) patients underwent surgical intervention for NEC. The overall survival rate was 161/191 (84.3%). A CRP/ALB ratio of ≥ 3 on day 2 of NEC diagnosis was associated with a statistically significant higher likelihood for surgery [AUC 0.71 (95% CI 0.63–0.79); p < 0.0001] and mortality [AUC 0.66 (95% CI 0.54–0.77); p = 0.0150], respectively. Conclusions A CRP/ALB ratio of ≥ 3 on day 2 is indicative of a critical pathway in neonates with radiologically confirmed, non-perforated NEC. This could be used as an additional criterion to guide parental counselling in NEC for surgical intervention and mortality.

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Management of Intestinal Strictures Post Conservative Treatment of Necrotizing Enterocolitis: The Long Term Outcome

Journal of Neonatal Surgery ◽

10.21699/jns.v5i3.379 ◽

2016 ◽

Vol 5 (3) ◽

pp. 28 ◽

Cited By ~ 6

Author(s):

Christoph Heinrich Houben ◽

Kin Wai Chan ◽

Wai Cheung Mou ◽

Yuk Him Tam ◽

Kim Hung Lee

Keyword(s):

Necrotizing Enterocolitis ◽

Death Rate ◽

Primary Anastomosis ◽

Colon Surgery ◽

C Reactive Protein ◽

Term Outcome ◽

Long Term Outcome ◽

Reactive Protein

Objectives: Evaluating the long-term outcome of the surgical management for intestinal strictures developing after necrotizing enterocolitis (NEC).Patients and methods: This is a retrospective study of all patients with an intestinal stricture after completion of conservative management for NEC. They were treated during the eight years period from 1st January 2008 to 31st December 2015.Results: During the study period 67 infants had an operation for NEC, of which 55 had emergency surgery. The remaining twelve infants (6 males) had a stricture and were included in the study group. Their median gestational age was 35 (range 27-40) weeks and the median weight was 2180 (range 770 - 3290) g. The onset of NEC was seen at a median of 2 (range 1- 47) days. The median peak C-reactive protein (CRP) level was 73.1 (range 25.2 – 232) mg/dl. Isolated strictures were seen in 9 (75%) patients. Two-third of all strictures (n=15) were located in the colon. Surgery was done at a median of 5 (range 3 - 13) weeks after diagnosing NEC. Primary anastomosis was the procedure of choice; only one needed a temporary colostomy. This cohort had no mortality during a median follow up of 6.25 (range 0.5 - 7.6) years, whilst the overall death rate for NEC was 15 (22 %). Two fifth of the group developed a neurological / sensory impairment.Conclusion: One fifth of the surgical workload for NEC is related to post-NEC strictures. Most strictures are located in the colonic region. In the long-term no mortality and no surgical co-morbidities were observed.

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Serum calprotectin, C-reactive protein and procalcitonin in preterm infants with necrotizing enterocolitis

Российский педиатрический журнал ◽

10.18821/1560-9561-2016-19-4-217-222 ◽

2019 ◽

Vol 19 (4) ◽

pp. 217-222

Author(s):

Tatyana N. Shishkina ◽

I. E. Smirnov ◽

A. G. Kucherenko ◽

Yu. I. Kucherov ◽

M. G. Rekhviashvili

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Sharp Increase ◽

Acute Phase Proteins ◽

Prognostic Significance ◽

Significant Decline ◽

Blood Levels ◽

C Reactive Protein ◽

Blood Concentrations ◽

Reactive Protein

Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in preterm infants. The development of NEC is associated with changes in the expression of a number of acute phase proteins and cytokines, such as C-reactive protein (CRP), procalcitonin (PCT), calprotectin (CP). To determine their diagnostic and prognostic significance there were performed studies of the dynamics of the blood levels of CRP, PCT and CP in preterm infants with NEC. A total of 68 premature infants with conservative and surgical stages of the NEC were examined. In all patients at admission, 3rd and 7th day of the treatment there was determined the serum concentration of CRP, PCT and CP. The gradual significant decline in CRP, PCT and CP. Blood concentrations was established at the 7th day of the observation ofpatients with conservative stage of NEC, which was associated with a favorable outcome of the treatment of NEC in this group of preterm infants. More pronounced changes in these markers in the blood of patients with surgical stage of the SEC due to a sharp increase in concentration and a lack of the decline in their content in the course of treatment, are associated with severe NEC and are a formidable sign of unfavorable course of the NEC, which requires timely revision and optimization of the treatment of such patients.

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Zonulin: A Potential Marker of Intestine Injury in Newborns

Disease Markers ◽

10.1155/2017/2413437 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Anna Tarko ◽

Anna Suchojad ◽

Marta Michalec ◽

Małgorzata Majcherczyk ◽

Aniceta Brzozowska ◽

...

Keyword(s):

Necrotizing Enterocolitis ◽

Statistical Significance ◽

Demographic Data ◽

C Reactive Protein ◽

Rotavirus Infection ◽

Reactive Protein ◽

Presenting Symptoms ◽

Potential Marker ◽

Intestinal Pathology ◽

Rotavirus Infections

Introduction.Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology.Material and Methods.Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC), rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns). ZO concentration was compared to C-reactive protein (CRP) and procalcitonin (PCT) values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS).Results.Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0–43.2) and 20.3 (1-3Q: 17.7–28.2) ng/ml, resp.) versus controls (3.5 (1-3Q: 2.7–4.8) ng/ml). Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ZO levels were not related to NTISS, CRP, and PCT.Conclusions.Zonulin is a promising biomarker of intestinal condition, markedly elevated in rotavirus infections. Its role in defining the severity of necrotizing enterocolitis and the risk for perforation is not well described and needs further evaluation. An increase in zonulin may not be parallel to the release of inflammatory markers, and low CRP should not exclude an injury to neonatal intestine.

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