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Low Abdominal NIRS Values and Elevated Plasma Intestinal Fatty Acid-Binding Protein in a Premature Piglet Model of Necrotizing Enterocolitis.

Zamora IJ, Stoll B, Ethun CG, Sheikh F, Yu L, Burrin DG, Brandt ML, Olutoye OO - PLoS ONE (2015)

Bottom Line: NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04).Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001).In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States of America.

ABSTRACT
To identify early markers of necrotizing enterocolitis (NEC), we hypothesized that continuous abdominal near-infrared spectroscopy (A-NIRS) measurement of splanchnic tissue oxygen saturation and intermittent plasma intestinal fatty-acid binding protein (pI-FABP) measured every 6 hours can detect NEC prior to onset of clinical symptoms. Premature piglets received parenteral nutrition for 48-hours after delivery, followed by enteral feeds every three hours until death or euthanasia at 96-hours. Continuous A-NIRS, systemic oxygen saturation (SpO2), and heart rate were measured while monitoring for clinical signs of NEC. Blood samples obtained at 6-hour intervals were used to determine pI-FABP levels by ELISA. Piglets were classified as fulminant-NEC (f-NEC), non-fulminant-NEC (nf-NEC) and No-NEC according to severity of clinical and histologic features. Of 38 piglets, 37% (n=14) developed nf-NEC, 18% (n=7) developed f-NEC and 45% (n=17) had No-NEC. There were significant differences in baseline heart rate (p=0.008), SpO2 (p<0.001) and A-NIRS (p<0.001) among the three groups. A-NIRS values of NEC piglets remained lower throughout the study with mean for f-NEC of 69±3.8%, 71.9±4.04% for nf-NEC, and 78.4±1.8% for No-NEC piglets (p<0.001). A-NIRS <75% predicted NEC with 97% sensitivity and 97% specificity. NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04). Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001). In f-NEC piglets, pI-FABP increased precipitously after feeds (0.04 to 1.87 ng/mL;p<0.001). pI-FABP levels increased in parallel with disease progression and a value >0.25ng/mL identified animals with NEC (68% sensitivity and 90% specificity). NIRS is a real-time, non-invasive tool that can serve as a diagnostic modality for NEC. In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels. These modalities may help identify neonates with NEC prior to clinical manifestations of disease.

No MeSH data available.


Related in: MedlinePlus

Intestinal Fatty Acid Binding Protein (I-FABP) in Plasma.Plasma I-FABP values stratified by NEC severity groups demonstrating a precipitous rise in the f-NEC group shortly after the initiation of feeds and a more gradual rise in the nf-NEC group that paralleled clinical disease progression. The No-NEC piglets never had an appreciable rise in their serum I-FABP.
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pone.0125437.g008: Intestinal Fatty Acid Binding Protein (I-FABP) in Plasma.Plasma I-FABP values stratified by NEC severity groups demonstrating a precipitous rise in the f-NEC group shortly after the initiation of feeds and a more gradual rise in the nf-NEC group that paralleled clinical disease progression. The No-NEC piglets never had an appreciable rise in their serum I-FABP.

Mentions: During the first 48 h of the study while piglets were strictly on TPN and prior to enteral feeds, there were no appreciable levels of plasma I-FABP and low levels of SAA detected, indicating minimal intestinal tissue injury. Once enteral feeds were initiated SAA levels increased progressively in all piglets following feeds but there was no significant difference between the three groups (Fig 7), while pI-FABP levels were significantly higher in animals that developed NEC compared to healthy piglets (0.66 vs. 0.09 ng/mL, p<0.001). When stratified by NEC severity, in piglets that developed fulminant disease, pI-FABP increased precipitously after feeds (0.04 to 1.87 ng/mL; p<0.001) and the spike was observed following the 3rd feed (Fig 8). The non-fulminant NEC group had a slower disease progression, with most exhibiting the first signs of NEC about 18–24 h after the initiation of feeds. This phenotype of the disease was also reflected in a more gradual increase in pI-FABP levels (0.01 to 3.03 ng/mL; p<0.001), and levels increased in parallel with disease progression. Although levels reached a higher peak than the fulminant NEC group, we suspect given the steep slope of the pI-FABP in the f-NEC group, peak levels would have been much higher but those piglets succumbed to their disease earlier. The No-NEC piglets never demonstrated any significant rise in pI-FABP levels throughout the duration of the study. On ROC curve analysis we identified a cutoff value of pI-FABP > 0.25 ng/mL, which identified animals progressing to NEC with 68% sensitivity and 90% specificity.


Low Abdominal NIRS Values and Elevated Plasma Intestinal Fatty Acid-Binding Protein in a Premature Piglet Model of Necrotizing Enterocolitis.

Zamora IJ, Stoll B, Ethun CG, Sheikh F, Yu L, Burrin DG, Brandt ML, Olutoye OO - PLoS ONE (2015)

Intestinal Fatty Acid Binding Protein (I-FABP) in Plasma.Plasma I-FABP values stratified by NEC severity groups demonstrating a precipitous rise in the f-NEC group shortly after the initiation of feeds and a more gradual rise in the nf-NEC group that paralleled clinical disease progression. The No-NEC piglets never had an appreciable rise in their serum I-FABP.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4465330&req=5

pone.0125437.g008: Intestinal Fatty Acid Binding Protein (I-FABP) in Plasma.Plasma I-FABP values stratified by NEC severity groups demonstrating a precipitous rise in the f-NEC group shortly after the initiation of feeds and a more gradual rise in the nf-NEC group that paralleled clinical disease progression. The No-NEC piglets never had an appreciable rise in their serum I-FABP.
Mentions: During the first 48 h of the study while piglets were strictly on TPN and prior to enteral feeds, there were no appreciable levels of plasma I-FABP and low levels of SAA detected, indicating minimal intestinal tissue injury. Once enteral feeds were initiated SAA levels increased progressively in all piglets following feeds but there was no significant difference between the three groups (Fig 7), while pI-FABP levels were significantly higher in animals that developed NEC compared to healthy piglets (0.66 vs. 0.09 ng/mL, p<0.001). When stratified by NEC severity, in piglets that developed fulminant disease, pI-FABP increased precipitously after feeds (0.04 to 1.87 ng/mL; p<0.001) and the spike was observed following the 3rd feed (Fig 8). The non-fulminant NEC group had a slower disease progression, with most exhibiting the first signs of NEC about 18–24 h after the initiation of feeds. This phenotype of the disease was also reflected in a more gradual increase in pI-FABP levels (0.01 to 3.03 ng/mL; p<0.001), and levels increased in parallel with disease progression. Although levels reached a higher peak than the fulminant NEC group, we suspect given the steep slope of the pI-FABP in the f-NEC group, peak levels would have been much higher but those piglets succumbed to their disease earlier. The No-NEC piglets never demonstrated any significant rise in pI-FABP levels throughout the duration of the study. On ROC curve analysis we identified a cutoff value of pI-FABP > 0.25 ng/mL, which identified animals progressing to NEC with 68% sensitivity and 90% specificity.

Bottom Line: NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04).Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001).In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States of America.

ABSTRACT
To identify early markers of necrotizing enterocolitis (NEC), we hypothesized that continuous abdominal near-infrared spectroscopy (A-NIRS) measurement of splanchnic tissue oxygen saturation and intermittent plasma intestinal fatty-acid binding protein (pI-FABP) measured every 6 hours can detect NEC prior to onset of clinical symptoms. Premature piglets received parenteral nutrition for 48-hours after delivery, followed by enteral feeds every three hours until death or euthanasia at 96-hours. Continuous A-NIRS, systemic oxygen saturation (SpO2), and heart rate were measured while monitoring for clinical signs of NEC. Blood samples obtained at 6-hour intervals were used to determine pI-FABP levels by ELISA. Piglets were classified as fulminant-NEC (f-NEC), non-fulminant-NEC (nf-NEC) and No-NEC according to severity of clinical and histologic features. Of 38 piglets, 37% (n=14) developed nf-NEC, 18% (n=7) developed f-NEC and 45% (n=17) had No-NEC. There were significant differences in baseline heart rate (p=0.008), SpO2 (p<0.001) and A-NIRS (p<0.001) among the three groups. A-NIRS values of NEC piglets remained lower throughout the study with mean for f-NEC of 69±3.8%, 71.9±4.04% for nf-NEC, and 78.4±1.8% for No-NEC piglets (p<0.001). A-NIRS <75% predicted NEC with 97% sensitivity and 97% specificity. NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04). Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001). In f-NEC piglets, pI-FABP increased precipitously after feeds (0.04 to 1.87 ng/mL;p<0.001). pI-FABP levels increased in parallel with disease progression and a value >0.25ng/mL identified animals with NEC (68% sensitivity and 90% specificity). NIRS is a real-time, non-invasive tool that can serve as a diagnostic modality for NEC. In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels. These modalities may help identify neonates with NEC prior to clinical manifestations of disease.

No MeSH data available.


Related in: MedlinePlus