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54 Faecal calprotectin levels in infants with congenital heart disease: cross-sectional pilot study
  1. Graeme OConnor,
  2. Andrew Taylor,
  3. Timothy Thiruchelvam
  1. Great Ormond Street Hospital

Abstract

Introduction Infants with duct-dependent circulation defects experience suboptimal splanchnic perfusion resulting in gut inflammation, which is exacerbated by cardiac surgery and enteral feeding, increasing the risk of necrotising enterocolitis (NEC). NEC leads to extensive feed interruptions contributing to poor growth particularly during the early post-operative phase but continuing up until discharge. Poor growth and longer hospital stay are risk factors for death in infants with congenital heart disease. Calprotectin (36.5kDa) is a neutrophil activation marker which is exhibited in the cytoplasm of neutrophils and expressed on activated monocytes and macrophages, leading to the recruitment of leukocytes to inflamed intestinal tissue and hence a measure of gut inflammation (normal faecal calprotectin level <50 mg/kg.

Methods Faecal calprotectin levels have been measured in 30 neonates with a duct-dependent circulation defects using ELISA methods. Samples are collected post-surgery once feeding is established and bowels open – healthy calprotectin <50 mg/l. Infants followed a high risk feeding protocol (starting at 0.5ml/kg) consisting of either expressed breast milk or hydrolysed formula Pepti-junior. Infants with suspected NEC underwent an abdominal radiography.

Results The incidence of suspected NEC was 20%. The mean faecal calprotectin level for infants with NEC was significantly higher (3957 mg/kg; SD 1130) compared to those without (excluding HLHS) 338 mg/kg; SD 285 (95% CI 1182, 4708; p-value <0.001).

Infants with HLHS have higher baseline calprotectin levels 2184 mg/kg compared to other duct-dependent circulation infants 338 mg/kg; SD 285 (p-value 0.01).

Infants who developed NEC took on average 10 days (SD 3) longer to establish 100ml/kg/day feed. No correlation was found between Cardiopulmonary Bypass (mins), cross clamp (mins) or weight (kg) and calprotectin (p-value 0.4).

Conclusion Faecal calprotectin is a marker for NEC and a potential predictive marker. Minimising unnecessary feed withdrawal and eliminating abdominal radiography and exposure to radiation.

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