OBJECTIVE: In this prospective, observational study, we determined whether serum C-reactive protein (CRP) correlated with necrotizing enterocolitis (NEC) stages II and III. We hypothesized that serial CRP measurement if used as an adjunct to abdominal radiographs would improve the identification of infants with NEC. METHODS: Serum CRP level was measured every 12 hours for 3 measurements and, when abnormal, once daily. When clinical signs persisted and the initial abdominal radiographs were abnormal, follow-up radiographs were obtained. RESULTS: Of 241 infants who were evaluated for gastrointestinal signs, 11 had ileus or benign pneumatosis intestinalis with persistently normal CRP; gastrointestinal manifestations resolved within 48 hours, antibiotics were discontinued in <48 hours, and feedings were restarted early without complications. Fifty-five infants had NEC stages II and III; all had abnormal CRP regardless of their blood culture results. In infants with stage II NEC, CRP returned to normal at a mean of 9 days except in those who developed complications such as stricture or abscess formation. CONCLUSIONS: In infants with suspected NEC, normal serial CRP values would favor aborted antibiotic therapy and early resumption of feedings. CRP becomes abnormal in both stage II and stage III NEC. In infants with NEC, persistently elevated CRP after initiation of appropriate medical management suggests associated complications, which may require surgical intervention.
OBJECTIVE: In this prospective, observational study, we determined whether serum C-reactive protein (CRP) correlated with necrotizing enterocolitis (NEC) stages II and III. We hypothesized that serial CRP measurement if used as an adjunct to abdominal radiographs would improve the identification of infants with NEC. METHODS: Serum CRP level was measured every 12 hours for 3 measurements and, when abnormal, once daily. When clinical signs persisted and the initial abdominal radiographs were abnormal, follow-up radiographs were obtained. RESULTS: Of 241 infants who were evaluated for gastrointestinal signs, 11 had ileus or benign pneumatosis intestinalis with persistently normal CRP; gastrointestinal manifestations resolved within 48 hours, antibiotics were discontinued in <48 hours, and feedings were restarted early without complications. Fifty-five infants had NEC stages II and III; all had abnormal CRP regardless of their blood culture results. In infants with stage II NEC, CRP returned to normal at a mean of 9 days except in those who developed complications such as stricture or abscess formation. CONCLUSIONS: In infants with suspected NEC, normal serial CRP values would favor aborted antibiotic therapy and early resumption of feedings. CRP becomes abnormal in both stage II and stage III NEC. In infants with NEC, persistently elevated CRP after initiation of appropriate medical management suggests associated complications, which may require surgical intervention.
Authors: Karl G Sylvester; Xuefeng B Ling; Gigi Yuen-Gee Liu; Zachary J Kastenberg; Jun Ji; Zhongkai Hu; Shuaibin Wu; Sihua Peng; Fizan Abdullah; Mary L Brandt; Richard A Ehrenkranz; Mary Catherine Harris; Timothy C Lee; B Joyce Simpson; Corinna Bowers; R Lawrence Moss Journal: J Pediatr Date: 2014-01-14 Impact factor: 4.406
Authors: Karl G Sylvester; Xuefeng B Ling; G Y Liu; Zachary J Kastenberg; Jun Ji; Zhongkai Hu; Sihua Peng; Ken Lau; Fizan Abdullah; Mary L Brandt; Richard A Ehrenkranz; Mary Catherine Harris; Timothy C Lee; Joyce Simpson; Corinna Bowers; R Lawrence Moss Journal: Gut Date: 2013-09-18 Impact factor: 23.059
Authors: Camilia R Martin; Melissa Bellomy; Elizabeth N Allred; Raina N Fichorova; Alan Leviton Journal: Fetal Pediatr Pathol Date: 2012-09-24 Impact factor: 0.958