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Faecal calprotectin concentrations in neonates with CHD: pilot study

Published online by Cambridge University Press:  03 April 2020

Graeme O’Connor Open the ORCID record for Graeme O’Connor [Opens in a new window] ,
Katherine L. Brown  and
Andrew M. Taylor
Graeme O’Connor*
Affiliation:
Heart and Lung Department, Cardiothoracic Intensive Care Unit, Great Ormond Street Children’s Hospital, London, UK Population, Policy and Practice Research Department, Nutrition Unit, Institute of Child Health and University College London, London, UK
Katherine L. Brown
Affiliation:
Heart and Lung Department, Cardiothoracic Intensive Care Unit, Great Ormond Street Children’s Hospital, London, UK Population, Policy and Practice Research Department, Nutrition Unit, Institute of Child Health and University College London, London, UK
Andrew M. Taylor
Affiliation:
Heart and Lung Department, Cardiothoracic Intensive Care Unit, Great Ormond Street Children’s Hospital, London, UK Population, Policy and Practice Research Department, Nutrition Unit, Institute of Child Health and University College London, London, UK Centre for Translational Cardiovascular Imaging, Cardiovascular Imaging, Institute of Child Health and University College London, London, UK
*
Author for correspondence: G. O’Connor, Great Ormond Street Children’s Hospital, Great Ormond Street, LondonWC1N 3JH, UK. Tel: +4402074059200; Fax: +4478138515. E-mail: graeme.oconnor@nhs.net
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Abstract

Neonates with CHD are at increased risk of developing necrotising enterocolitis due to mesenteric hypoperfusion. Necrotising enterocolitis results in repeated feed interruptions contributing to poor growth during the early post-operative phase. Poor weight gain and longer hospital stay are risk factors for death in neonates with CHD. Abdominal radiography is used as a diagnostic tool for necrotising enterocolitis; however, its utility is limited in the early stages of necrotising enterocolitis when pneumatosis intestinalis is absent. Calprotectin is a neutrophil activation biomarker, and elevated levels are evident in inflammatory diseases such as necrotising enterocolitis. The aim of this study was to determine whether there is a correlation between faecal calprotectin concentration and gut inflammation in neonates with CHD. This prospective single-centre study recruited newly diagnosed term patients with duct-dependent CHD between March 2018 and March 2019. Faecal calprotectin concentrations were measured in post-surgical patients using enzyme-linked immunosorbent assay methods. A total of 30 patients were included in the analysis. Calprotectin concentration for patients who developed necrotising enterocolitis was 3528 µg/g compared with 390 µg/g without, compared with 1339 µg/g in patients with suspected necrotising enterocolitis (p = 0.0001). Patients with suspected necrotising enterocolitis had a significantly longer length of hospital stay, on average 18 days longer compared to patients without necrotising enterocolitis (p = 0.03). Faecal calprotectin concentrations may reflect severity of gut inflammation in neonates with CHD. Suspected necrotising enterocolitis contributes to longer days nil by mouth and an increase in length of hospital stay.

Keywords

CHDfaecal calprotectinnecrotising enterocolitissuspected necrotising enterocolitisfeeding
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 5 , May 2020 , pp. 624 - 628
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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References

Lau, PE, Cruz, SM, Ocampo, EC, et al. Necrotizing enterocolitis in patients with congenital heart disease: a single center experience. J Pediatr Surg 2018; 53(5): 914–917.CrossRefGoogle ScholarPubMed
Kelleher, DK, Laussen, P, Teixeira-Pinto, A, Duggan, C.Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22(3): 237–244.CrossRefGoogle ScholarPubMed
Overman, RE Jr., Criss, CN, Gadepalli, SK.Necrotizing enterocolitis in term neonates: a different disease process? J Pediatr Surg 2019; 54(6): 1143–1146.CrossRefGoogle ScholarPubMed
Neu, J, Walker, WA.Necrotizing Enterocolitis. N Engl J Med 2011; 364(3): 255–264.CrossRefGoogle ScholarPubMed
Pickard, SS, Feinstein, JA, Popat, RA, Huang, L, Dutta, S.Short- and Long-Term Outcomes of Necrotizing Enterocolitis in Infants With Congenital Heart Disease. Pediatrics 2009; 123(5): e901.10.1542/peds.2008-3216CrossRefGoogle Scholar
Sharma, R, Hudak, ML.A clinical perspective of necrotizing enterocolitis: past, present, and future. Clin Perinatol 2013; 40(1): 27–51.CrossRefGoogle ScholarPubMed
Golbus, JR, Wojcik, BM, Charpie, JR, Hirsch, JC.Feeding complications in hypoplastic left heart syndrome after the Norwood procedure: a systematic review of the literature. Pediatr Cardiol 2011; 32(4): 539–552.10.1007/s00246-011-9907-xCrossRefGoogle ScholarPubMed
Iannucci, GJ, Oster, ME, Mahle, WT.Necrotising enterocolitis in infants with congenital heart disease: the role of enteral feeds. Cardiol Young 2013; 23(4): 553–559.CrossRefGoogle ScholarPubMed
Bell, MJ, Ternberg, JL, Feigin, RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187(1): 1–7.10.1097/00000658-197801000-00001CrossRefGoogle ScholarPubMed
Giannone, PJ, Luce, WA, Nankervis, CA, Hoffman, TM, Wold, LE.Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 2008; 82(7–8): 341–347.CrossRefGoogle ScholarPubMed
Schuchardt, EL, Kaufman, J, Lucas, B, et al. Suspected necrotising enterocolitis after surgery for CHD: an opportunity to improve practice and outcomes. Cardiology in the Young 2018; 28(5): 639–646.CrossRefGoogle ScholarPubMed
Medoff-Cooper, B, Irving, SY, Hanlon, AL, et al. The Association among Feeding Mode, Growth, and Developmental Outcomes in Infants with Complex Congenital Heart Disease at 6 and 12 Months of Age. J Pediatr 2016; 169: 154–159.e1.CrossRefGoogle ScholarPubMed
Eskedal, LT, Hagemo, PS, Seem, E, et al. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93(6): 495–501.CrossRefGoogle ScholarPubMed
Curzon, CL, Milford-Beland, S, Li, JS, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 2008; 135(3): 546–551.CrossRefGoogle Scholar
Gephart, SM, Gordon, PV, Penn, AH, et al. Changing the paradigm of defining, detecting, and diagnosing NEC: perspectives on Bell’s stages and biomarkers for NEC. Semin Pediatr Surg 2018; 27(1): 3–10.10.1053/j.sempedsurg.2017.11.002CrossRefGoogle ScholarPubMed
Pergialiotis, V, Konstantopoulos, P, Karampetsou, N, et al. Calprotectin levels in necrotizing enterocolitis: a systematic review of the literature. Inflamm Res 2016; 65(11): 847–852.CrossRefGoogle ScholarPubMed
Yui, S, Nakatani, Y, Mikami, M.Calprotectin (S100A8/S100A9), an Inflammatory Protein Complex from Neutrophils with a Broad Apoptosis-Inducing Activity. Biol Pharm Bull 2003; 26(6): 753–760.10.1248/bpb.26.753CrossRefGoogle Scholar
Elgin, TG, Kern, SL, McElroy, SJ.Development of the Neonatal Intestinal Microbiome and Its Association With Necrotizing Enterocolitis. Clin Ther 2016; 38(4): 706–715.CrossRefGoogle ScholarPubMed
Oord, T, Hornung, N.Fecal calprotectin in healthy children. Scand J Clin Lab Invest 2014; 74(3): 254–258.10.3109/00365513.2013.879732CrossRefGoogle ScholarPubMed
Walsh, MC, Kliegman, RM.Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33(1): 179–201.CrossRefGoogle ScholarPubMed
Mukherjee, D, Zhang, Y, Chang, DC, et al. Outcomes analysis of necrotizing enterocolitis within 11 958 neonates undergoing cardiac surgical procedures. Arch Surg 2010; 145(4): 389–392.CrossRefGoogle ScholarPubMed
Hehir, DA, Easley, RB, Byrnes, J.Noncardiac Challenges in the Cardiac ICU: feeding, Growth and Gastrointestinal Complications, Anticoagulation, and Analgesia. World J Pediatr Congenit Heart Surg 2016; 7(2): 199–209.CrossRefGoogle ScholarPubMed
Arbra, CA, Oprisan, A, Wilson, DA, Ryan, RM, Lesher, AP.Time to reintroduction of feeding in infants with nonsurgical necrotizing enterocolitis. J Pediatr Surg 2018; 53(6): 1187–1191.10.1016/j.jpedsurg.2018.02.082CrossRefGoogle ScholarPubMed