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Am J Perinatol 2021; 38(13): 1435-1441
DOI: 10.1055/s-0040-1713406
Original Article

Plasma Citrulline as a Biomarker for Early Diagnosis of Necrotizing Enterocolitis in Preterm Infants

Nilima Jawale
1   Division of Neonatology, Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York
,
Mallory Prideaux
1   Division of Neonatology, Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York
,
Malavika Prasad
1   Division of Neonatology, Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York
,
Malki Miller
1   Division of Neonatology, Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York
,
Shantanu Rastogi
1   Division of Neonatology, Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York
2   George Washington University Hospital, Children's National Health System, Washington, DC
,
for Maimonides Neonatal Group › Author Affiliations Funding All phases of this study were supported by a resident research grant at Maimonides Medical Center.
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Abstract

Objective Citrulline synthesized by healthy enterocytes and decreases with injury. This work aimed to study plasma citrulline concentrations (CITs) as a biomarker to differentiate among infants presenting with early nonspecific signs and symptoms of necrotizing enterocolitis (NEC) with those who will develop NEC. Further to study the correlation between posttreatment CIT with time to full feeds (TTFF) and length of stay (LOS).

Study Design This is a prospective study which included infants < 32 weeks gestational age (GA) with 9 infants each in Group 1 (stage 2/3 NEC), Group 2 (with stage 1 NEC-like presentation), and Group 3 (healthy GA-matched infants). CIT was measured in Groups 1 and 2 within 24 hours of presentation and again in Group 1 after treatment.

Results The three groups were similar in clinical characteristics. Median CIT (µmol/L) in Group 1 (15.4 [interquartile range, IQR: 7.3–18.0]) was lower than Group 2 (22.2 [IQR: 18.3–27.3], p = 0.02) and Group 3 (24.9 [IQR: 19.8–31.9], p = 0.009). Posttreatment CIT in Group 1 did not correlate with TTFF (r = 0.15; p = 0.69) and LOS (r =  − 0.33; p = 0.38).

Conclusion CIT was lower in infants with NEC as compared with healthy controls and those infants with nonspecific signs of NEC. CIT after treatment does not correlate with TTFF and LOS.

Key Points

  • Citrulline is produced by enterocytes.

  • It is decreased in infants with necrotizing enterocolitis early in disease.

  • It can be used as a biomarker for early diagnosis of necrotizing enterocolitis.

Keywords

citrulline - necrotizing enterocolitis - preterm - biomarker - case–control

* Other members of Maimonides Medical Group are Alok Bhutada, MD, Michele Dyan, MD, Anju Gupta-Modak, MD, Panayot Filipov, MD, Tania Mangones, MD, and Melissa Tsai, MD.




Publication History

Received: 24 March 2020

Accepted: 14 May 2020

Article published online:
30 June 2020

© 2020. Thieme. All rights reserved.

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