Yenidoğanlarda Nekrotizan Enterokolit ve Benzeri Klinik Tablolarda Serolojik Belirteçlerin Değerlendirilmesi

Abstract

Necrotizing enterocolitis (NEC) is a devastating condition of the neonatal period characterized by bowel necrosis and multisystem organ failure. Currently, intestinal ischemia is believed to be a critical secondary factor rather than being the primary insult in the pathophysiology of the disease. We aimed to evaluate the role of hypoxia-ischemia in the pathophysiology of classic NEC and NEC like clinical pictures both by evaluating the clinical parameters and some serological markers including L-lactate, endotheline-1 (ET-1), platelet activating factor (PAF) and intestinal fatty acid binding protein (I-FABP). This prospective study was performed in Hacettepe University, Ihsan Dogramaci Childrens? Hospital, Neonatal Intensive Care Unit between 1 July 2010-1 September 2012. Preterm infants who showed ?NEC like? clinical picture in the first week of life were assigned as ?early NEC group? and those who developed NEC after the seventh day of life were assigned as ?Classic NEC group? while preterm infants who did not show any gastrointestinal signs during the hospitalization period were assigned as the control group. In all cases, blood samples were obtained at the time of delivery and during the symptomatic period for analyzing the levels of lactate, ET-1, PAF and I-FABP. The demographic, clinical and laboratory characteristics of the groups were compared. 86 preterm infants were enrolled in the study and of these 24 (27.9%) were in early NEC group, 19 (22.1%) were in classic NEC group and 43 (50.0%) were in the control group. The incidences of fetal Doppler velocimetry abnormalities, intrauterine growth restriction and small-for-gestational age infants were significantly higher in early NEC group than in classic NEC group. While stage I NEC was more frequent in early NEC group, stage II NEC was more frequent in classic NEC group. However, the levels of lactate, ET-1, PAF, and I-FABP in the first blood samples were significantly higher in early NEC group (p=0.006, 0.007, 0.000 and 0.000, respectively). In the second blood samples, L-lactate was higher in early NEC group, PAF and I-FABP were higher in classic NEC group and ET-1 was similar in three groups (p=0.002, 0.000, 0.000 and 0.063, respectively). Our results suggest that in early NEC, the main pathophysiologic insult leading to the clinical picture was likely to be intestinal hypoxic ischemic injury, subsequent inflammation and dismotility which is different than classical NEC. The clinical spectrum of NEC is very heterogenous and a new pathophysiological classification and staging system is needed to optimize preventive and therapeutic strategies.