Bloodstream infections during the onset of necrotizing enterocolitis and their relation with the pro-inflammatory response, gut wall integrity and severity of disease in NEC

F. H. Heida*, J. B. F. Hulscher, M. Schurink, M. J. van Vliet, E. M. W. Kooi, D. C. Kasper, M. Pones, A. F. Bos, T. M. Benkoe

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)

Abstract

Introduction: Bacterial involvement is believed to play a pivotal role in the development and disease outcome of NEC. However, whether a bloodstream infection (BSI) predisposes to NEC (e.g. by activating the pro-inflammatory response) or result from the loss of gut wall integrity during NEC development is a longstanding question.

Objective: We hypothesize that the occurrence of a BSI plays a complementary role in the pathogenesis of NEC. The first aim of the study was to correlate the occurrence of a BSI during the early phase of NEC with intestinal fatty acid-binding protein (I-FABP) levels, as a marker for loss of gut wall integrity owing to mucosal damage, and Interleukin (IL)-8 levels, as a biomarker for the pro-inflammatory cascade in NEC. The second aim of the study was to investigate the relation between the occurrence of a BSI and disease outcome.

Material and methods: We combined data from prospective trials from two large academic pediatric surgical centers. Thirty-eight neonates with NEC, 5 neonates with bacterial sepsis, and 14 controls were included.

Results: BSIs occurred in 10/38 (26%) neonates at NEC onset. No association between the occurrence of BSIs and I-FABP levels in plasma (cohort 1: median 11 ng/mL (range 0.8-298), cohort 2: median 6.8 ng/mL (range 1.3-15)) was found in NEC patients (cohort 1: p = 0.41; cohort 2: p = 0.90). In addition, the occurrence of BSIs did not correlate with IL-8 (median 1562 pg/mL (range 150-7,500); p = 0.99). While the occurrence of a BSI was not correlated with Bell's stage (p = 0.85), mortality was higher in patients with a BSI (p = 0.005).

Conclusion: The low incidence of BSIs and the absent association of both the markers for loss of gut wall integrity and the pro-inflammatory response during the early phase of NEC, support the hypothesis that the presence of a BSI does not precede NEC. (C) 2015 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)1837-1841
Number of pages5
JournalJournal of Pediatric Surgery
Volume50
Issue number11
DOIs
Publication statusPublished - Nov-2015

Keywords

  • Necrotizing enterocolitis
  • Pathophysiology
  • Bloodstream infections
  • Proinflammatory cascade response
  • Gut wall integrity
  • ACID-BINDING PROTEIN
  • INFANTS
  • INTERLEUKIN-8
  • PATHOGENESIS
  • BIOMARKERS
  • CULTURES
  • FAILURE
  • MARKERS
  • HEALTH

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