Kann ein Gewichtssprung in Kombination mit einem Anstieg des Interleukin-8 eine nekrotisierende Enterokolitis bei Neonaten vorhersagen?

Zusammenfassung

Hintergrund: Eine Gewichtszunahme vor der klinischen Diagnose einer nekrotisierenden Enterokolitis (NEC) wird als prädiktiver Faktor beschrieben. Hypothese: Eine Gewichtszunahme größer 5% am Tag vor dem klinischen Verdacht in Kombination mit einer Erhöhung des Plasma-IL-8 ist prädiktiv für eine NEC.

Methodik: In einer Fall-Kontroll-Studie wurden 48 Neugeborene mit NEC Stadium II und III eingeschlossen. Gesamte orale und parenterale Nahrungszufuhr, Ausscheidung und Kinetik von Gewicht und IL-8 wurden dokumentiert.

Ergebnisse: 31 Neugeborenen mit NEC-II und 17 Patienten mit NEC-III wurden eingeschlossen. Eine Gewichtszunahme >5% zeigten 35,3% der Neugeborene mit NEC-III, 0% mit NEC-II und 4,2% in der Kontrollgruppe. Das IL-8 hingegen stieg zum Zeitpunkt des V.a. NEC signifikant an [NEC-III (6 561,4 pg/ml) vs. NEC-II (326,7 pg/ml) vs. Kontrollgruppe (38,9 pg/ml) p<0,05)]. Die Sensitivität von IL-8 war bei NEC-II 87,10% (70,15–96,25) und bei NEC-III 100,00% (80,33–100,00). Die Sensitivität der Gewichtszunahme betrug bei NEC-II 0,00% (0,00–11,32) und bei NEC-III 35,29% (14,30–61,65).

Schlussfolgerung: Eine Gewichtszunahme >5% zeigte sich nur in 35,3% der Fälle mit NEC-III. Eine Kombination von Gewichtszunahme und Anstieg des IL-8 verbesserte die Diagnostik einer nicht.

Abstract

Background: Weight gain before the clinical diagnosis of necrotising enterocolitis (NEC) is described as a predictive factor. Hypothesis: Weight gain of more than 5% one day prior to clinical suspicion plus increase of plasma Iinterleukin-8 (IL-8) are predictive for NEC.

Methods: 48 infants with diagnosis of NEC stage II and III were enrolled in a case-control study. Oral and parenteral nutrition, diuresis and kinetics of weight and of IL-8 were documented.

Results: 31 infants with NEC-II and 17 infants with NEC-III were enrolled. Weight gain >5% occurred in 35.3% of NEC-III, in 0% of NEC-II and in 4.2% of the control group. IL-8 increased significantly [NEC-III (6 561.4 pg/mL) vs. NEC-II: (326.7 pg/mL) vs. control group (38.9 pg/mL); p<0.05]. Sensitivity of IL-8 in NEC-II was 87.10% (70.15–96.25) and in NEC-III 100.00% (80.33–100.00). Sensitivity of weight gain was 0.00% (0.00–11.32) in NEC-II and 35.29% (14.30–61.65) in NEC-III.

Conclusion: Weight gain >5% was found in only 35.3% of the cases with NEC-III. Combination of weight gain and IL-8 did not improve the diagnosis of NEC.

Schlüsselwörter

Frühgeborene - nekrotisierende Enterokolitis - Interleukin-8 - Gewichtszunahme - Neonate

Key words

preterm infants - necrotising enterocolitis - interleukin-8 - weight gain - neonates

• Literatur

• 1 Atkinson SD, Tuggle DW, Tunell WP. Hypoalbuminemia may predispose infants to necrotizing enterocolitis. Journal of pediatric surgery 1989; 24: 674-676
• 2 Speer J, Gahr M. Die nekrotisierende Enterokolitis. Pädiatrie. 2. Auflage (ed.) Springer; 2001: 233-235
• 3 Crissinger K, Ryckman F, Flake A et al. Necrotizing enterocolitis: epidemiologic, clinical and pathologic features. In: Faranoff A, Martin R. (eds.) Neonatal- Perinatal Medicine: Diseases of the Fetus and Infant Mosby CV. 1997: 1333-1344
• 4 Morag I, Goldman M, Kuint J et al. Excessive weight gain as a possible predictor of necrotizing enterocolitis in premature infants. The Israel Medical Association journal: IMAJ 2007; 9: 24-27
• 5 Walsh MC, Kliegman RM, Hack M. Severity of necrotizing enterocolitis: influence on outcome at 2 years of age. Pediatrics 1989; 84: 808-814
• 6 Obladen M. Necrotizing enterocolitis – 150 years of fruitless search for the cause. Neonatology 2009; 96: 203-210
• 7 Beeby PJ, Jeffery H. Risk factors for necrotising enterocolitis: the influence of gestational age. Archives of disease in childhood. 1992; 67 (4 Spec No) 432-435
• 8 Bosse U, Abel HT, Bannert N et al. Necrotizing enterocolitis in the newborn infant. Pathogenetic risk factors in a 3 year analysis. Monatsschrift Kinderheilkunde: Organ der Deutschen Gesellschaft für Kinderheilkunde 1993; 141: 602-606
• 9 Kanto Jr WP, Wilson R, Breart GL et al. Perinatal events and necrotizing enterocolitis in premature infants. American journal of diseases of children (1960) 1987; 141: 167-169
• 10 Finnstrom O, Olausson PO, Sedin G et al. The Swedish national prospective study on extremely low birthweight (ELBW) infants. Incidence, mortality, morbidity and survival in relation to level of care. Acta paediatrica (Oslo, Norway: 1992) 1997; 86: 503-511
• 11 Snyder CL, Gittes GK, Murphy JP et al. Survival after necrotizing enterocolitis in infants weighing less than 1 000 g: 25 years’ experience at a single institution. Journal of pediatric surgery 1997; 32 434-437
• 12 Leitlinien der Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin Bakterielle Infektion bei Neugeborenen 2006
• 13 Lindley I, Westwick D, Kunkel SL. Nomenclature announcement – the chemokines. J Immunol today 1993; 14-24
• 14 Baggiolini M, Walz A, Kunkel SL. Neutrophil-activating peptide-1/interleukin 8, a novel cytokine that activates neutrophils. The Journal of clinical investigation 1989; 84: 1045-1049
• 15 Schroder JM, Mrowietz U, Morita E et al. Purification and partial biochemical characterization of a human monocyte-derived, neutrophil-activating peptide that lacks interleukin 1 activity. Journal of immunology (Baltimore, Md.: 1950) 1987; 139: 3474-3483
• 16 Martich GD, Danner RL, Ceska M et al. Detection of interleukin 8 and tumor necrosis factor in normal humans after intravenous endotoxin: the effect of antiinflammatory agents. The Journal of experimental medicine 1991; 173: 1021-1024
• 17 Morgan LJ, Shochat SJ, Hartman GE. Peritoneal drainage as primary management of perforated NEC in the very low birth weight infant. Journal of pediatric surgery 1994; 29: 310-314 discussion 314–315
• 18 Franz AR, Kron M, Pohlandt F et al. Comparison of procalcitonin with interleukin 8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infections in newborn infants. The Pediatric infectious disease journal 1999; 18: 666-671
• 19 Franz AR, Steinbach G, Kron M et al. Reduction of unnecessary antibiotic therapy in newborn infants using interleukin-8 and C-reactive protein as markers of bacterial infections. Pediatrics 1999; 104 (3 Pt 1) 447-453
• 20 Franz AR, Steinbach G, Pohlandt F. Interleukin 8 (Il-8) Is A Sensitive and Specific Marker for Early Onset Neonatal Bacterial Infection (Eobi) and Nosocomial Bacterial Infection (Nbi) in Preterm Infants (Pi). Pediatr Res 1997; 42: 401-401
• 21 Edelson MB, Bagwell CE, Rozycki HJ. Circulating pro- and counterinflammatory cytokine levels and severity in necrotizing enterocolitis. Pediatrics 1999; 103 (4 Pt 1) 766-771
• 22 Harris MC, D’Angio CT, Gallagher PR et al. Cytokine elaboration in critically ill infants with bacterial sepsis, necrotizing entercolitis, or sepsis syndrome: correlation with clinical parameters of inflammation and mortality. The Journal of pediatrics 2005; 147 462-468
• 23 Bell MJ, Ternberg JL, Feigin RD et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Annals of surgery 1978; 187: 1-7
• 24 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatric clinics of North America 1986; 33: 179-201
• 25 Harms K, Ludtke FE, Lepsien G et al. Necrotizing enterocolitis: symptomatology, diagnosis and therapeutic consequences. Langenbecks Archiv für Chirurgie 1994; 379: 256-263
• 26 Sonntag J, Wagner MH, Waldschmidt J et al. Multisystem organ failure and capillary leak syndrome in severe necrotizing enterocolitis of very low birth weight infants. Journal of pediatric surgery 1998; 33 481-484
• 27 Markel TA, Crisostomo PR, Wairiuko GM et al. Cytokines in necrotizing enterocolitis. Shock (Augusta, Ga).. 2006; 25 329-337
• 28 Baruti Gafurri Z, Pacarizi H, Zhubi B et al. The importance of determining procalcitonin and C reactive protein in different stages of sepsis. Bosnian journal of basic medical sciences/Udruzenje basicnih mediciniskih znanosti. =Association of Basic Medical Sciences 2010; 10: 60-64
• 29 Srinivasjois R, Nathan E, Doherty D et al. Prediction of progression of definite necrotising enterocolitis to need for surgery or death in preterm neonates. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies. the International Society of Perinatal Obstet 2010; 23: 695-700
• 30 Heimann K, Schoberer M, posielek J et al. C-The Ratio of Abdominal Circumference and Body Weight – an Objective Parameter for the Daily Ward Round in a NICU?. Klein Pediatr 2014; 226: 72-75
• 31 Verboon-Maciolek MA, Thijsen SFT, Hemels MAC et al. Inflammatory Mediators for the Diagnosis and Treatment of Sepsis in Early Infancy. Pediatr Res 2006; 59: 457-461