Babu Sharmila, Prasad Malavika, Miller Malki, Morrissey Mark, Bhutada Alok, Rojas Mary, Rastogi Shantanu
Maimonides Medical Center, Maimonides Infant and Children's Hospital, 4802 Tenth Ave, F-119, Brooklyn, NY, 11219, USA.
Morgan Stanley Children's Hospital of New York, Columbia University, New York, NY, USA.
Pediatr Surg Int. 2019 Jun;35(6):715-722. doi: 10.1007/s00383-019-04470-9. Epub 2019 Mar 9.
Necrotizing enterocolitis (NEC), a leading cause of mortality and morbidity in preterm neonates, lacks a reliable biomarker. Citrulline is primarily produced by enterocytes and correlates with intestinal function. Serum citrulline concentration (CIT) is routinely measured in routine newborn screening (NBS). The purpose of the study is to test if CIT from NBS may predict the occurrence of NEC and whether it correlates with the time to full feeds (TTFF) and length of stay (LOS), serving as a biomarker of NEC and intestinal health.
In a retrospective case control study conducted on neonates with gestational age of 26-32 weeks, we compared CIT levels between cases (neonates with NEC) and controls (next-born neonate). NBS was collected within first 24 h, at day 5 and when the neonates achieved full feeds and were compared using non-parametric tests.
There was no difference in CIT between the controls and cases on day 1 [11.42 (7.42-14.84 vs. 11.93 (6.85-18.8) µmol/L, p = 0.55], on day 5 [11.99 (7.99-16.55) vs. 13.70 (7.42-26.83) µmol/L, p = 0.05], or at full feeds [14.86 (6.85-25.69) vs. 15.7 (7.42-26.26) µmol/L, p = 0.87]. CIT on day 1 did not correlate with TTFF (r = 0.08, p = 0.53) or LOS (r = 0.23, p = 0.06), respectively).
CIT from routine NBS does not serve as a biomarker to predict NEC in preterm neonates.
坏死性小肠结肠炎（NEC）是早产新生儿死亡和发病的主要原因，目前缺乏可靠的生物标志物。瓜氨酸主要由肠上皮细胞产生，与肠道功能相关。血清瓜氨酸浓度（CIT）在常规新生儿筛查（NBS）中常规检测。本研究的目的是检验NBS中的CIT是否可预测NEC的发生，以及它是否与完全经口喂养时间（TTFF）和住院时间（LOS）相关，作为NEC和肠道健康的生物标志物。
在一项对胎龄为26 - 32周的新生儿进行的回顾性病例对照研究中，我们比较了病例组（患有NEC的新生儿）和对照组（下一个出生的新生儿）的CIT水平。NBS在出生后24小时内、第5天以及新生儿完全经口喂养时采集，并使用非参数检验进行比较。
第1天对照组和病例组的CIT无差异[11.42（7.42 - 14.84）对11.93（6.85 - 18.8）µmol/L，p = 0.55]，第5天[11.99（7.99 - 16.55）对13.70（7.42 - 26.83）µmol/L，p = 0.05]，或完全经口喂养时[14.86（6.85 - 25.69）对15.7（7.42 - 26.26）µmol/L，p = 0.87]。第1天的CIT分别与TTFF（r = 0.08，p = 0.53）或LOS（r = 0.23，p = 0.06）均无相关性。
常规NBS中的CIT不能作为预测早产新生儿NEC的生物标志物。
