Program Schedule

Rapid Detection of Neonatal Immune System Activation

Session: Poster Abstract Session: Biomarkers of Immune Responses
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • Slide1.PNG (1.0 MB)
  • Background:  Inter alpha inhibitor proteins (IAIP) are natural serine protease inhibitors that play a crucial role in modulating host response to inflammatory insults. Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are serious morbidities affecting premature infants with overlapping features. It is important to distinguish them earlier as etiology and therefore management may differ. We examined if blood levels of IAIP differ in infants with NEC compared to those with SIP and matched controls.

    Methods:  Prospective observational unmasked study. Blood and clinical data were collected serially at and after presentation from infants diagnosed with NEC, SIP and matched controls admitted to NICU of Women and Infants Hospital. Infants with NEC were diagnosed by Bell's staging criteria (≥ stage 2 or 3). Infants with SIP were diagnosed by clinical and radiological findings. Controls were matched for gestational age, gender and weight. IAIP levels were measured via a competitive enzyme-linked immunosorbent assay which has a sensitivity of 50 mcg/ml, intra-assay variability (coefficient of variation, CV) of <3% and inter-assay CV of <7%. Mean biomarker levels were subjected to ANOVA and Student Newman Keuls analysis.

    Results: There were 28 infants studied in three groups.

    NEC (n=5) SIP (n=6) Controls (n=17) P Value
    Gestational age, weeks* 275±34 264±15 275±26 0.64
    Age at presentation, days* 12.2±11.5 8.1±4.8 10.2±7.1 0.11
    Birth weight, grams* 1025±705 825±243 1067±570 0.69
    Gender, male % 20% 66% 35% 0.25
    IAIP at presentation, mcg/ml* 139 ± 21 319 ± 72 276 ± 110 0.01

    Mean±SD IAIP levels measured serially on days 1, 3 and 5 after initial presentation in infants with NEC (170±40, 201±19 and 239±24 mcg/ml) were significantly lower than those with SIP (269±64, 377±84 and 326±47 mcg/ml respectively) (p<0.05).

    Conclusion:   IAIP levels are decreased in states of immune system activation. As a biomarker, IAIP may assist in early detection of NEC and distinguish NEC from SIP. This distinction at presentation may lead to earlier effective treatments and improved outcomes including long term neurodevelopmental sequelae. Since IAIP correlates with disease progression, it may serve as a surrogate to monitor response to therapy in NEC.

    Birju Shah, MD, MPH, Yow-Pin Lim, PhD and James Padbury, MD, Pediatrics, Alpert Medical School, Women and Infants Hospital of Rhode Island, Brown University, Providence, RI


    B. Shah, None

    Y. P. Lim, ProThera Biologics: Employee, Research grant and Salary

    J. Padbury, None

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