330 - Defining the preclinical window of necrotizing enterocolitis using host proteins found in stool

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 330
Publication Number: 330.133

Rebecca Buckley, LSU School of Medicine, New Orleans, LA, United States; Anne Tufton, Louisiana State University School of Medicine in New Orleans, New Orleans, LA, United States; Virginia Ronchi, LSUHSC-School of Medicine, New Orleans, LA, United States; Maya Heath, Pediatrix, Richardson, TX, United States; KELLY C. LABORDE, Woman's Hospital, Baton Rouge, LA, United States; Derek Wiltz, Louisiana State University School of Medicine in New Orleans, New Orleans, LA, United States; Lana F. Thaljeh, Louisiana State University School of Medicine in New Orleans, New Orleans, LA, United States; Misty Good, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Brian Barkemeyer, Louisiana State University School of Medicine in New Orleans, New Orleans, LA, United States; Steven B.. Spedale, MD FAAP, Woman's Hospital, Baton Rouge, LA, United States; Lee McDaniel, LSU Health Sciences Center, New Orleans, LA, United States; Zhide Fang, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, United States; Sunyoung Kim, LSU School of Medicine, New Orleans, LA, United States

Presenting Author(s)

RB

Rebecca Buckley, PhD

Research Assistant Professor
LSU School of Medicine
New Orleans, Louisiana, United States

Background: Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal disease with a high morbidity and mortality in preterm infants. Current methods can only detect NEC in advanced stages and lack sensitivity and specificity. Fecal intestinal alkaline phosphatase (iAP) has shown to be a promising molecular biomarker for NEC with sensitivity and specificity over 95%.

Objective:

This study assessed if biochemical changes in iAP can be detected prior to radiologic evidence of disease for its use as a prognostic marker for early NEC detection.

Design/Methods:

In this prospective, longitudinal study, 269 preterm infants were recruited from 4 hospitals with neonatal intensive care units (NICUs); 10% developed severe NEC, 15% were suspected of NEC, and 75% did not develop NEC. Stool was collected from enrolled infants throughout their hospital stay. An average of 8 serial samples per enrollee were analyzed for iAP abundance and activity. Demographic data were collected upon enrollment and clinical records were monitored daily for development of disease.

Results: In infants with severe and suspected NEC, changes in iAP biochemistry were observed prior to clinical evidence of disease. IAP protein levels were elevated but iAP activity was suppressed compared to post-conceptional age-matched controls. A hazard ratio of aberrant iAP measures indicates a 19-fold likelihood of developing NEC compared to controls.

Conclusion(s): Our results suggest that changes in iAP biochemistry can be used to assess risk and diagnose disease earlier than x-ray. This study highlights fecal iAP as a potential prognostic marker for NEC that may help direct clinical management decisions and shows promise as a companion diagnostic in clinical trials of NEC therapeutics.