Secretor phenotype and genotype are novel predictors of severe outcomes in premature infants

Abstract

BackgroundThe secretor gene (FUT2) and its products have important role in mucosal maturation, immunity, and host susceptibility to pathogens. We conducted the first investigation of secretor phenotype and genotype of premature infants in relation to their risk of death, necrotizing enterocolitis (NEC; Bell's stage II and III), and confirmed sepsis.MethodsSecretor phenotype was measured in infant saliva samples by enzyme immunoassay of H antigen, the primary antigen produced by transferases of secretor gene. The optimal cut‐point in salivary H values was identified and confirmed by computerized algorithms (CART and ROC analysis).ResultsOf the 410 study infants, 14% with low salivary H died, compared to 2% of infants with high salivary H (p<0.001). Modeled with clinical covariates, low H remained significant, and the overall model highly predicted death. Low H antigen was also associated with 10‐fold or greater odds of NEC and sepsis deaths, 3‐fold higher odds of surgical NEC and 2‐fold higher odds of NEC. Similarly, secretor genotype was a significant predictor: 13% of non‐secretors, 5% of heterozygotes, and 2% of secretor dominant infants died (p=0.01).ConclusionsLack of secretor antigen predicts adverse outcomes in prematurity. Sponsorship NICHD HD13021, HD059140