Division of Pediatric Surgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
J Pediatr Surg. 2011 Jan;46(1):81-5. doi: 10.1016/j.jpedsurg.2010.09.069.
We hypothesized that a subset of premature newborns has subclinical, intestinal mucosal compromise that predisposes to the development of necrotizing enterocolitis (NEC) days or weeks later.
Fifty-five newborns of 23 to 36 weeks' gestational age were identified, and urine was collected over the first 90 hours of life. The urinary concentration of intestinal fatty acid binding protein (iFABP(u)), a sensitive marker for intestinal injury, was determined. The diagnosis of NEC was based upon clinical condition, pathology, and/or imaging findings.
Neonatal iFABP(u) exceeded 800 pg/mL in 27 subjects, including 9 of 9 who subsequently developed stage 2 or 3 NEC. This degree of iFABP(u) elevation, but not asphyxia, was significantly associated with the development of NEC (P < .01).
In this population of premature newborns, there was a substantial incidence of intestinal mucosal compromise. All infants who subsequently developed stage 2 or 3 NEC had an elevated iFABP(u). This finding suggests a model for the pathogenesis of some cases of NEC, whereby perinatal mucosal injury predisposes to further damage when feedings are initiated. In addition, neonatal iFABP(u) assessment may represent a tool to identify infants at the highest risk for NEC and allow for the institution of focused, preventive measures.
我们假设早产儿中有一部分存在亚临床的肠道黏膜损伤，使他们在数天或数周后更容易发展为坏死性小肠结肠炎（NEC）。
选择胎龄 23 至 36 周的 55 名新生儿，在出生后的前 90 小时内采集尿液。测定尿液中肠脂肪酸结合蛋白（iFABP(u)）的浓度，这是一种敏感的肠道损伤标志物。NEC 的诊断依据临床情况、病理和/或影像学发现。
27 名受试者的新生儿 iFABP(u)超过 800pg/mL，其中 9 名随后发展为 2 或 3 期 NEC。这种程度的 iFABP(u)升高，而不是窒息，与 NEC 的发生显著相关（P<.01）。
在本早产儿人群中，存在大量的肠道黏膜损伤。所有随后发展为 2 或 3 期 NEC 的婴儿均有 iFABP(u)升高。这一发现提示了某些 NEC 病例的发病机制模型，即围产期黏膜损伤使在开始喂养时更容易进一步受损。此外，新生儿 iFABP(u)评估可能代表一种识别 NEC 风险最高的婴儿的工具，并允许采取有针对性的预防措施。
