Abstract
Objective A temporal relationship has been reported between necrotizing enterocolitis, anemia,
and red blood cell transfusion (RBCT) in preterm neonates. However, the mechanism
underlying this association is not clearly defined. Intestinal (I-) and liver (L-)
fatty acid binding proteins (FABPs) have been proposed as plasma markers for the detection
of acute intestinal injury. This study aimed to investigate the effect of anemia and
RBCT on intestinal injury in preterm neonates by measuring serum I-FABP and L-FABP
levels.
Study Design A prospective cohort study including preterm neonates with gestational age <32 weeks
and/or birth weight <1,500 g and requiring erythrocyte transfusions for anemia after
day 15 of life was conducted. Stable growing preterm infants with hemoglobin values
≥ 10 g/dL were taken as controls. I-FABP and L-FABP levels of the neonates with anemia
were compared with levels of the control group. In addition, pretransfusion I-FABP
and L-FABP levels of the neonates with anemia were compared with posttransfusion levels.
Results In total, 39 infants transfused for anemia and 20 controls were enrolled. L-FABP
levels were significantly higher in neonates with anemia compared with controls (p < 0.001), whereas I-FABP (p = 0.695) was not different. L-FABP and I-FABP levels were similar before and after
transfusion in neonates with anemia. L-FABP levels before transfusion were negatively
correlated with pretransfusion hemoglobin levels (p < 0.001).
Conclusion Anemia is associated with intestinal injury documented by increased L-FABP levels
in preterm infants, and this injury is more severe with lower hemoglobin levels.
Keywords
anemia in the preterm neonate - fatty acid binding proteins - intestinal injury -
necrotizing enterocolitis - red blood cell transfusion
