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J Pediatr Surg. 2014 Feb;49(2):273-6. doi: 10.1016/j.jpedsurg.2013.11.037. Epub 2013 Nov 21.

The relationship between reticulated platelets, intestinal alkaline phosphatase, and necrotizing enterocolitis.

Author information

1
Loyola University Medical Center, Maywood, IL, USA.
2
Hutt Valley District Health Board, Wellington, New Zealand.
3
Ann and Robert H. Lurie Children's Hospital at Cadence Health, Winfield, IL, USA.
4
University of Illinois at Chicago, Chicago, IL, USA.
5
Loyola University Medical Center, Maywood, IL, USA. Electronic address: jmurask@lumc.edu.

Abstract

BACKGROUND:

Necrotizing enterocolitis (NEC) affects up to 10% of extremely-low-birthweight infants, with a 30% mortality rate. Currently, no biomarker reliably facilitates early diagnosis. Since thrombocytopenia and bowel ischemia are consistent findings in advanced NEC, we prospectively investigated two potential biomarkers: reticulated platelets (RP) and intestinal alkaline phosphatase (iAP).

METHODS:

Infants born ≤ 32 weeks and/or ≤ 1500 g were prospectively enrolled from 2009 to 2012. Starting within 72 hours of birth, 5 weekly whole blood specimens were collected to measure RP and serum iAP. Additional specimens were obtained at NEC onset (Bell stage II or III) and 24 hours later. Dichotomous cut-points were calculated for both biomarkers. Non-parametric (Mann-Whitney) and Chi-square tests were used to test differences between groups. Differences in Kaplan-Meier curves were examined by log-rank test. The Cox proportional hazards model estimated hazard ratios.

RESULTS:

A total of 177 infants were enrolled in the study, 15 (8.5%) of which developed NEC (40% required surgery and 20% died). 14 (93%) NEC infants had "low" (≤ 2.3%) reticulated platelets, and 9 (60%) had "high" iAP (>0 U/L) in at least one sample before onset. Infants with "low" RP were significantly more likely to develop NEC [HR=11.0 (1.4-83); P=0.02]. Infants with "high" iAP were at increased risk for NEC, although not significant [HR=5.2 (0.7-42); P=0.12]. Median iAP levels were significantly higher at week 4 preceding the average time to NEC onset by one week (35.7 ± 17.3 days; P=0.02).

CONCLUSION:

Decreased RP serves as a sensitive marker for NEC onset, thereby enabling early preventative strategies. iAP overexpression may signal NEC development.

KEYWORDS:

Biomarker; Extremely-low-birthweight; Necrotizing enterocolitis; Premature

PMID:
24528965
PMCID:
PMC4423723
DOI:
10.1016/j.jpedsurg.2013.11.037
[Indexed for MEDLINE]
Free PMC Article
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