DIAGNOSTIC VALUE OF INTESTINAL FATTY ACID-BINDING PROTEIN (I-FABP) IN PRETERM INFANTS WITH NECROTIZING ENTEROCOLITIS

Abstract

Introduction. Necrotizing enterocolitis (NEC) is characterized by loss of gut wall integrity. Fatty acid binding protein (I-FABP) in blood serum allows to isolate infants in the early stages of the NEC and correlates with the severity of the disease. This protein is involved in the transport of polar lipids, such as fatty acids from the lumen of the small intestine.Aim of work: to determine diagnostic value of fatty acid binding protein (I-FABP) in blood serum in preterm children with necrotizing enterocolitis.Materials and methods. Under supervision there were 67 preterm children with NEC. The children were divided into groups depending on the severity of the NEC. Prior to the first group were involved 20 preterm infants with the NEC of IA and IB stage, and to the second group were involved 30 premature infants from the NEC of IIA and IIB stage and to the third group were involved 7 preterm infants with NEC of IIIA stage. The control group comprised 10 preterm infants without NEC. The content of the protein bound to fatty acids, the intestinal form (I-FABP) in serum was determined by the immunoassay method of the Human I-FABP (Hycult Biotech, Netherlands) kit according to the manufacturer's instructions.Results and discussion. Children of the III group had significantly lower body mass (p<0.05) and gestational period at birth than children of the control group.All children with NEC involved in the study had an increase in the serum I-FABP content. Thus, in the I group, the I-FABP content was 796,0 [579-961] pg/ml, in group II - 1031,0 [873-1630] pg/ml, in group IІІ - 1698,0 [1598-2953] pg/ml, which significantly exceeded the value of I-FABP in control group children - 269,5 [252-289] pg/ml (p<0.05). Also, there was a significant difference in I-FABP content in preterm infants with NEC, depending on the severity of the disease, the higher the stage, the higher the I-FABP content (p<0.05). Diagnostic value of I-FABP in blood serum of prematurely born children with necrotizing enterocolitis, depending on severity, determined by ROC analysis. The most diagnostic value of I-FABP is for the diagnosis of NEC grade III. I-FABP ≥ 1484.0 pg/ml allows to identify NEC of III stage in preterm children with a sensitivity of 85.7% and a specificity of 82.0%. The area under the curve (AUC) is 0.880 [95% CI 0.784-0.976], which indicates a high diagnostic value of the model.Conclusions. The heavier course of NEC is associated with lower body weight (p<0.05) and lower gestational age. In all children who were born prematurely with necrotizing enterocolitis, the content of intestinal fatty acid-binding protein (I-FABP) in serum was elevated. The highest level of I-FABP (1698,0 [1598-2953] pg/ml) was observed in preterm infants with necrotizing enterocolitis of the third stage (p<0.05). The I-FABP index ≥1484.0 pg/ml allows to identify preterm infants with necrotizing enterocolitis of III stage with a sensitivity of 85.7% and a specificity of 82.0%, the area under the curve 0.880 [95% CI 0.784-0.976], which confirms the results of the ROC analysis.