Fecal calprotectin excretion in preterm infants during the neonatal period

Abstract

Background: Fecal calprotectin has been proposed as a non-invasive marker of intestinal inflammation in inflammatory bowel disease in adults and children. Fecal calprotectin levels have been reported to be much higher in both healthy full-term and preterm infants than in children and adults.

Objective: To determine the time course of fecal calprotectin (f-calprotectin) excretion in preterm infants from birth until hospital discharge and to identify factors influencing f-calprotectin levels in the first weeks of life, including bacterial establishment in the gut.

Methodology: F-calprotectin was determined using an ELISA assay in 147 samples obtained prospectively from 47 preterm infants (gestational age, and birth-weight interquartiles 27-29 weeks, and 880-1320 g, respectively) at birth, and at 2-week intervals until hospital discharge.

Principal findings: Although median f-calprotectin excretion was 138 microg/g, a wide range of inter- and intra-individual variation in f-calprotectin values (from day 3 to day 78) was observed (86% and 67%, respectively). In multivariate regression analysis, f-calprotectin correlated negatively with ante and per natal antibiotic treatment (p = 0.001), and correlated positively with the volume of enteral feeding (mL/kg/d) (p = 0.009), the need to interrupt enteral feeding (p = 0.001), and prominent gastrointestinal colonization by Clostridium sp (p = 0.019) and Staphylococcus sp (p = 0.047).

Conclusion: During the first weeks of life, the high f-calprotectin values observed in preterm infants could be linked to the gut bacterial establishment.

Figure 1. Fecal calprotectin levels in preterm infants with or without antenatal antibiotherapy.

The boxplot shows the median (central horizontal line) and includes the 25^th (lower box border) to 75^th percentile (upper box border) of fecal calprotectin (µg/g of feces) in preterm infants with (74 fecal samples) and without (73 fecal samples) antenatal antibiotherapy following the postconceptional age (weeks).

Figure 2. Fecal calprotectin levels in preterm infants without or with poor tolerance to enteral feeding.

Fecal calprotectin in preterm infants without poor tolerance to enteral feeding (i.e. with unplanned enteral feeding interruption, n = 118), and with poor tolerance to enteral feeding (i.e. with unplanned enteral feeding interruption, n = 7). The boxplot shows the median (central horizontal line) and includes the 25^th (lower box border) to 75^th percentile (upper box border). Dotted line represents cut-off level (205 µg/g of feces) for poor tolerance to enteral feeding (see text for details).

Figure 3. Fecal calprotectin as a function of the tercile of enteral feeding volume and tolerance to enteral feeding.

The median and interquartile range of fecal calprotectin are plotted for each volume of enteral feeding in infants with good (open boxes) or poor (closed boxes) tolerance to feeding. Poor tolerance to feeding was defined as the need for unplanned enteral feeding interruption.