Comparison of the efficacy of serum amyloid A, C-reactive protein, and procalcitonin in the diagnosis and follow-up of necrotizing enterocolitis in premature infants

Çetınkaya, Merih; Özkan, Hilal; Köksal, Nilgün; Akacı, Okan; Özgür, Taner

doi:10.1016/j.jpedsurg.2011.03.069

Cited by 52 publications

(32 citation statements)

References 37 publications

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“…Cetinkaya et al (2010) showed that 80% of neonates with Bell stage I and 100% of neonates with Bell stage II/III had elevated plasma SAA levels [4]. This group also showed that plasma SAA levels were significantly higher in Bell stage III compared with Bell stage I at time of NEC diagnosis and on the days following diagnosis [24]. It may be questionable whether Bell stage I represents actual NEC, as no intestinal pneumatosis is present in this stage, however the results indicate an association between SAA levels and NEC stage.…”

Section: Discussionmentioning

confidence: 93%

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Non-Invasive Serum Amyloid A (SAA) Measurement and Plasma Platelets for Accurate Prediction of Surgical Intervention in Severe Necrotizing Enterocolitis (NEC)

et al. 2014

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ObjectiveTo evaluate the value of biomarkers to detect severe NEC.Summary Background DataThe time point of surgery in necrotizing enterocolitis (NEC) is critical. Therefore, there is a need for markers that detect severe NEC, because clinical signs of severe NEC often develop late. This study evaluated the value of biomarkers reflecting intestinal cell damage and inflammation to detect severe NEC.Methods29 neonates with NEC were included. Two definitions of moderate versus severe NEC were analyzed: medical NEC (n = 12) versus surgical or fatal NEC (n = 17); and Bell stage II NEC (n = 13) versus stage III NEC (n = 16). Urinary intestinal fatty acid binding protein (I-FABP), serum amyloid A (SAA), C3a and C5a, and fecal calprotectin were measured. C-reactive protein (CRP), white blood cell count (WBC) and platelet count data were measured in blood.ResultsIn both definitions of moderate versus severe NEC, urinary SAA levels were significantly higher in severe NEC. A cut-off value of 34.4 ng/ml was found in surgical NEC versus medical NEC (sensitivity, 83%; specificity, 83%; LR+, 4.88 (95% CI, 1.37–17.0); LR−, 0.20 (95% CI, 0.07–0.60)) at diagnosis of NEC and at one day prior to surgery in neonates who were operated later on. Combination of urinary SAA and platelet count increased the accuracy, with a sensitivity, 94%; specificity, 83%; LR+, 5.53 (95% CI, 1.57–20.0); and LR−, 0.07 (95% CI, 0.01–0.48).ConclusionUrinary SAA is an accurate marker in differentiating severe NEC from moderate NEC; particularly if combined with serum platelet count.

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Section: Discussionmentioning

confidence: 93%

“…Recently, Ng et al reported that plasma SAA is a promising marker for the detection of NEC [16]. Furthermore, SAA in plasma has been reported to positively correlate with NEC stage [4], [24], [25]. In these studies, only the difference between Bell stages was investigated.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Serum Amyloid A (SAA) Measurement and Plasma Platelets for Accurate Prediction of Surgical Intervention in Severe Necrotizing Enterocolitis (NEC)

et al. 2014

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“…[16–18] Of the clinical predictors, several variables, such as CRP and WBC, have been reported previously and thus were expected. [6,19,20] Also, given that PCT is similar in reflecting the instestinal inflammation as CRP and WBC, we expected it to be predictive. The local intestinal inflammatory response, starting with the activation of mast cells, macrophages, and neutrophils, is thought to contribute to collagen deposition, fibrosis, and wound contraction, which are the pathogenesis of post-NEC strictures.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis

Zhang

Chen

Wang³

et al. 2017

Medicine

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Intestinal stricture is a severe and common complication of necrotizing enterocolitis (NEC), causing severe and prolonged morbidity. Our goal was to investigate the clinical predictors for strictures developing after NEC and evaluate the management outcome of the post-NEC strictures to better orient their medicosurgical care.A total of 188 patients diagnosed with NEC with identical treatment protocols throughout the period under study were retrospectively reviewed from 4 academic neonatal centers between from January 1, 2011, and October 31, 2016. Clinical predictive factors and clinical outcomes, including demographic information, clinical management, laboratory data, histopathology of resected bowel segment, and discharge summaries, were evaluated on the basis of with post-NEC strictures or not.Of the involved variables examined, the late-onset NEC [risk ratio (RR), 0.56; 95% confidence interval (95% CI), 0.41–0.92; P < 0.001], cesarean delivery (RR, 1.42; 95% CI, 0.98–2.29; P = 0.026), and first procalcitonin (PCT) (onset of symptoms) (RR, 1.82; 95% CI, 0.98–3.15; P = 0.009) were the independent predictive factors for the post-NEC strictures. C-reactive protein (CRP), white blood cell (WBC), and plateletcrit levels were markedly higher on infants with stricture and elevated levels were maintained until the stricture was healed. Infants with intestinal stricture had significantly longer times to beginning enteral feeds (23.9 ± 12.1), than infants without intestinal stricture (18.6 ± 8.8) (P = 0.023). The median age at discharge was also significantly higher in the group with stricture (P = 0.014).This retrospective and multicenter study demonstrates that the early-onset NEC and cesarean delivery conferred protection over the post-NEC stricture. Infants with post-NEC stricture need prolonged hospitalization.

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“…Biomarkers such as c-reactive protein, serum amyloid A, and procalcitonin have been shown to be effective tools for assessing and monitoring the inflammatory burden imposed upon neonates with nosocomial infections and necrotizing enterocolitis [24][25]. These biomarkers have potential to be helpful in determining extubation readiness in infants who develop postoperative infections while recovering from cardiac surgery and represent an exciting area for future research.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery*

Laudato

Gupta

Walters

et al. 2015

Pediatric Critical Care Medicine

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Objective: Extubation failure after neonatal cardiac surgery has been associated with considerable postoperative morbidity, though data identifying risk factors for its occurrence are sparse. We aimed to determine risk factors for extubation failure in our neonatal cardiac surgical population. Design: Retrospective chart reviewSetting: Urban tertiary care free-standing children's hospital Interventions: Extubation failure was defined as re-intubation within 72 hours after extubation from mechanical ventilation. Multivariate logistic regression analysis was performed to determine independent risk factors for extubation failure. Measurements & Main Conclusions:Neonates with underlying genetic abnormalities, hypoplastic left heart, or postoperative infection were at increased risk for extubation failure. A more conservative approach in these patients, including longer pre-extubation duration of antibiotic therapy for postoperative infections, may be warranted.3

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Comparison of the efficacy of serum amyloid A, C-reactive protein, and procalcitonin in the diagnosis and follow-up of necrotizing enterocolitis in premature infants

Cited by 52 publications

References 37 publications

Non-Invasive Serum Amyloid A (SAA) Measurement and Plasma Platelets for Accurate Prediction of Surgical Intervention in Severe Necrotizing Enterocolitis (NEC)

Non-Invasive Serum Amyloid A (SAA) Measurement and Plasma Platelets for Accurate Prediction of Surgical Intervention in Severe Necrotizing Enterocolitis (NEC)

Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis

Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery*

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