Fecal Calprotectin Concentrations in Premature Infants Have a Lower Limit and Show Postnatal and Gestational Age Dependence
Zoppelli L et al. – Fecal calprotectin (fCP) levels depend on gestational and postnatal age and in contrast to adults, there is a lower limit in premature infants. Taking these observations into account when defining reference values and interpreting fCP data in the clinical context, fCP can be a useful marker in identifying premature infants with gastrointestinal distress and necrotizing enterocolitis (NEC) in particular.Methods
- Between April 2008 and December 2009, 1,899 fecal samples were obtained from 206 very low birth weight infants.
- Mean gestational age (GA) was 28.5 weeks and birth weight 1,057 g. 19 (9.2%) patients developed NEC stage II+, of whom 5 had fulminant NEC with unusually low fCP concentrations in meconium and afterwards.
- fCP levels showed significant gestational and postnatal age dependent dynamics with particularly low levels in extremely premature infants.
- In infants with a GA <26 + 1 weeks using GA-adapted reference values, the sensitivity for discriminating moderate NEC from healthy infants and infants with intestinal distress was 0.89 for a cut-off of 180 and 210 ug/g, respectively, at onset of symptoms. Specificity was 0.96 and 0.84.
- Fulminant NEC was characterized by unusually low fCP concentrations with a cut-off of <24 ug/g having a sensitivity of 0.84 and a specificity of 0.72 for identifying those cases.