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Calprotectin als Marker für gastrointestinale Erkrankungen bei Frühgeborenen mit einem Geburtsgewicht <1500g – Ergebnisse einer Multicenterstudie
Background: Necrotising enterocolitis (NEC) is the most common gastrointestinal emergency in neonates with high mortality and morbidity especially in very low birth weight infants (VLBW).
Methods: In order to assess the suitability of fecal calprotectin levels as predictive marker for NEC in VLBW we started a prospective multi-centre study in May 2008. Up to September 2009, 227 patients were included with complete data available in 168 cases. The mean gestational age was 29.1 weeks (23.0–34.1) and mean birth weigt 1048g (354–1490g). 11 patients suffered from NEC defined as NEC-stage ≥ II (6.6%). 6 of those presented with classical and 5 with fulminant NEC defined as progression to NEC-stage III within 6 hours after onset of disease. The mean meconium calprotectin level in healthy VLBW was 158.5µg/kg (5.8–310.8) and was significantly higher compared to preterms who eventually developed NEC (36.6µg/kg;18.4–78.3; p=0.018). In all cases calprotectin levels increased above 450µg/kg. 5 out of 6 patients (83%) with classical presentation showed elevated calprotectin levels >250µg/g 24h before clinical suspicion of NEC. In contrast, calprotectin levels in patients with fulminant NEC did not increase before laparotomy. Discussion: Fecal calprotectin seem to be a sensitive marker for classical NEC. However, patients with a fulminant NEC do not show an increase in calprotectin levels early in the disease which might indicate to an impaired immunological response in such patients. Finally, VLBW who eventually developed NEC had significantly lower meconium calprotectin levels which might be suitable for early risk assessment of future NEC development.