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Use of serum citrulline concentrations from routine newborn screen as a biomarker for necrotizing enterocolitis

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Abstract

Purpose

Necrotizing enterocolitis (NEC), a leading cause of mortality and morbidity in preterm neonates, lacks a reliable biomarker. Citrulline is primarily produced by enterocytes and correlates with intestinal function. Serum citrulline concentration (CIT) is routinely measured in routine newborn screening (NBS). The purpose of the study is to test if CIT from NBS may predict the occurrence of NEC and whether it correlates with the time to full feeds (TTFF) and length of stay (LOS), serving as a biomarker of NEC and intestinal health.

Methods

In a retrospective case control study conducted on neonates with gestational age of 26–32 weeks, we compared CIT levels between cases (neonates with NEC) and controls (next-born neonate). NBS was collected within first 24 h, at day 5 and when the neonates achieved full feeds and were compared using non-parametric tests.

Results

There was no difference in CIT between the controls and cases on day 1 [11.42 (7.42–14.84 vs. 11.93 (6.85–18.8) µmol/L, p = 0.55], on day 5 [11.99 (7.99–16.55) vs. 13.70 (7.42–26.83) µmol/L, p = 0.05], or at full feeds [14.86 (6.85–25.69) vs. 15.7 (7.42–26.26) µmol/L, p = 0.87]. CIT on day 1 did not correlate with TTFF (r = 0.08, p = 0.53) or LOS (r = 0.23, p = 0.06), respectively).

Conclusions

CIT from routine NBS does not serve as a biomarker to predict NEC in preterm neonates.

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Funding

No external funding was secured for this study. The authors have indicated they have no financial relationships to disclose relevant to this article.

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Author notes

  1. Sharmila Babu and Malavika Prasad have equally contributed for the manuscript and are co-first authors.

Authors and Affiliations

  1. Maimonides Medical Center, Maimonides Infant and Children’s Hospital, 4802 Tenth Ave, F-119, Brooklyn, NY, 11219, USA

    Sharmila Babu, Malki Miller, Alok Bhutada, Mary Rojas & Shantanu Rastogi

  2. Morgan Stanley Children’s Hospital of New York, Columbia University, New York, NY, USA

    Malavika Prasad

  3. Wadsworth Center, NYS DOH, Albany, NY, USA

    Mark Morrissey

  4. Department of Pediatrics, SUNY-HSC at Brooklyn, Brooklyn, NY, USA

    Shantanu Rastogi

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  1. Sharmila Babu
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  2. Malavika Prasad
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Correspondence to Shantanu Rastogi.

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Babu, S., Prasad, M., Miller, M. et al. Use of serum citrulline concentrations from routine newborn screen as a biomarker for necrotizing enterocolitis. Pediatr Surg Int 35, 715–722 (2019). https://doi.org/10.1007/s00383-019-04470-9

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  • DOI: https://doi.org/10.1007/s00383-019-04470-9

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