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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

Proximal Jejunum Intestinal Fatty Acid Binding Protein (I-FABP) immunohistochemical staining.Immunohistochemistry fluorescent staining for I-FABP in proximal jejunum specimens. In these images I-FABP is represented in green. In the No-NEC piglets there is robust expression of I-FABP and in the NEC piglets the mucosa has been significantly denuded and I-FABP signal degraded.
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pone.0125437.g011: Proximal Jejunum Intestinal Fatty Acid Binding Protein (I-FABP) immunohistochemical staining.Immunohistochemistry fluorescent staining for I-FABP in proximal jejunum specimens. In these images I-FABP is represented in green. In the No-NEC piglets there is robust expression of I-FABP and in the NEC piglets the mucosa has been significantly denuded and I-FABP signal degraded.

Mentions: To assess whether the elevated I-FABP detected in the plasma originated from necrotic intestinal villi we performed I-FABP western blot analyses of proximal jejunum samples, which demonstrated NEC piglets had significantly lower amounts of I-FABP protein remaining in the intestinal villi at the time of death when compared to the No-NEC group (Fig 9). To more closely examine this relationship we utilized a Spearman’s rho analysis, which revealed a strong inverse correlation between mean tissue I-FABP densitometry levels and corresponding histologic tissue injury NEC scores (rs = -0.79, p< 0.001) (Fig 10). Further corroborating the western blot results, immunofluorescent histochemical staining revealed a strong I-FABP signal in the No-NEC jejunal tissue samples and a weak signal in the NEC tissue samples (Fig 11).


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)

Proximal Jejunum Intestinal Fatty Acid Binding Protein (I-FABP) immunohistochemical staining.Immunohistochemistry fluorescent staining for I-FABP in proximal jejunum specimens. In these images I-FABP is represented in green. In the No-NEC piglets there is robust expression of I-FABP and in the NEC piglets the mucosa has been significantly denuded and I-FABP signal degraded.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0125437.g011: Proximal Jejunum Intestinal Fatty Acid Binding Protein (I-FABP) immunohistochemical staining.Immunohistochemistry fluorescent staining for I-FABP in proximal jejunum specimens. In these images I-FABP is represented in green. In the No-NEC piglets there is robust expression of I-FABP and in the NEC piglets the mucosa has been significantly denuded and I-FABP signal degraded.
Mentions: To assess whether the elevated I-FABP detected in the plasma originated from necrotic intestinal villi we performed I-FABP western blot analyses of proximal jejunum samples, which demonstrated NEC piglets had significantly lower amounts of I-FABP protein remaining in the intestinal villi at the time of death when compared to the No-NEC group (Fig 9). To more closely examine this relationship we utilized a Spearman’s rho analysis, which revealed a strong inverse correlation between mean tissue I-FABP densitometry levels and corresponding histologic tissue injury NEC scores (rs = -0.79, p< 0.001) (Fig 10). Further corroborating the western blot results, immunofluorescent histochemical staining revealed a strong I-FABP signal in the No-NEC jejunal tissue samples and a weak signal in the NEC tissue samples (Fig 11).

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