Necrotizing enterocolitis (NEC) is a devastating bowel disease, preterm face. This study aimed to explore the role of fecal calprotectin (FCP) as a noninvasive marker of gastrointestinal (GI) injury in preterm infants to detect its usefulness in diagnosis and prediction of NEC severity. On 38 preterm infants a prospective cohort study was carried out. Eighteen preterm infants showed feeding intolerance (FI) and 20 showed feeding tolerances (controls). The preterm infants were recruited from the neonatal intensive care unit, Benha University Hospital, from June 2014 to Dec 2015.
FCP was estimated by ELISA in Baseline and follow-up samples. Hematologic parameters were also estimated. FCP showed non-significant baseline difference but was significantly increased at the 2nd sample in FI compared to controls. Within the FI group, highly significantly increased FCP was found in follow-up samples (2nd and 3rd) compared to the 1st.
FCP (2nd and 3rd) significantly elevated with increased severity of enteropathy grades. FCP (3rd) was highly significantly increased in died compared to survived infants. Significant positive correlations between FCP (2nd and 3rd) with both Bell's staging and CRP were found. Significant negative correlations between FCP (2nd) and platelets, pH, pCO2 and HCO3- but significant negative correlations between FCP (3rd) and hemoglobin, hematocrit, platelets, pH, HCO3- and sodium were found. FCP cutoff levels; 120.5µg/g for NEC occurrence, 128.7µg/g for definite NEC and 215.5µg/g for
advanced NEC were determined. To conclude, our study showed increased FCP in preterm with GI inflammation (particularly NEC) compared to controls, with a significant positive correlation with NEC severity. FCP could distinguish NEC from more benign FI. Serial measurements might be a useful non-invasive tool for prediction of NEC severity and prognosis