Fecal Calprotectin Level in Neonates with Necrotizing Enterocolitis

Background: Necrotizing enterocolitis (NEC) is a disease with high mortality. It is more present in premature infants and can also happen in term and late preterm neonates. It may affect any segment of the small intestine or colon. However, most commonly influences the terminal ileum and proximal ascending colon. This disease might damage the entire bowel, which can be irreversible. Intestinal mucosal defects cause the migration of large numbers of inflammatory cells into the gut lumen. Extensive mucosal affection results in increased calprotectin levels. This study aimed to investigate the role of fecal calprotectin as a non-invasive marker in the diagnosis of NEC for the better management of infants with NEC. Methods: This case-control cross-sectional study was performed in two groups. Group 1 was the case group consisting of the neonates admitted at Suez Canal University Hospital, Neonatal Intensive Care Unit with a clinical diagnosis of NEC. All cases were evaluated by Bell's staging criteria. Group 2 included control subjects. All the studied subjects had complete medical history, full physical examination, and laboratory investigations, including complete blood count, stool analysis, and C-reactive protein. Radiological examination entailed chest X-ray and erect abdomen X-ray, abdominal ultrasonography, and the measurement of stool calprotectin. Results: Fecal calprotectin level showed a positive strong correlation with NEC stages and this was statistically significant. Regarding the sequels of NEC, our study showed a positive correlation between NEC stage and fecal calprotectin level with r of 0.911 and P-value of < 0.001. The mean level of calprotectin in stage Ia was 226.9 mu g/g with the maximum in patients affected with stage IIb (875 mu g/g). Conclusion: According to the findings of this study, fecal calprotectin can be used as a marker in the diagnosis of NEC and has a strong positive correlation with the severity of NEC.