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Immediate Post-operative Enterocyte Injury, as Determined by Increased Circulating Intestinal Fatty Acid Binding Protein, Is Associated With Subsequent Development of Necrotizing Enterocolitis After Infant Cardiothoracic Surgery.
Abstract
Objectives: 1 Measure serial serum intestinal fatty acid binding protein levels in
infants undergoing cardiac surgery with cardiopulmonary bypass to evaluate for evidence
of early post-operative enterocyte injury. 2 Determine the association between immediate
post-operative circulating intestinal fatty acid binding protein levels and subsequent
development of necrotizing enterocolitis. Design: Observational cohort study. Intestinal
fatty acid binding protein was measured pre-operatively, at rewarming, and at 6 and
24 h post-operatively. Percent of goal enteral kilocalories on post-operative day
5 and episodes of necrotizing enterocolitis were determined. Multivariable analysis
assessed for factors independently associated with clinical feeding outcomes and suspected/definite
necrotizing enterocolitis. Setting: Quaternary free-standing children's hospital pediatric
cardiac intensive care unit. Patients: 103 infants <120 days of age undergoing cardiothoracic
surgery with cardiopulmonary bypass. Interventions: None. Results: Median pre-operative
intestinal fatty acid binding protein level was 3.93 ng/ml (range 0.24-51.32). Intestinal
fatty acid binding protein levels rose significantly at rewarming (6.35 ng/ml; range
0.54-56.97; p = 0.008), continued to rise slightly by 6 h (6.57 ng/ml; range 0.75-112.04;
p = 0.016), then decreased by 24 h (2.79 ng/ml; range 0.03-81.74; p < 0.0001). Sixteen
subjects (15.7%) developed modified Bell criteria Stage 1 necrotizing enterocolitis
and 9 subjects (8.8%) developed Stage 2 necrotizing enterocolitis. Infants who developed
necrotizing enterocolitis demonstrated a significantly higher distribution of intestinal
fatty acid binding protein levels at both 6 h (p = 0.005) and 24 h (p = 0.005) post-operatively.
On multivariable analysis, intestinal fatty acid binding protein was not associated
with percentage of goal enteral kilocalories delivered on post-operative day 5. Higher
intestinal fatty acid binding protein was independently associated with subsequent
development of suspected/definite necrotizing enterocolitis (4% increase in odds of
developing necrotizing enterocolitis for each unit increase in intestinal fatty acid
binding protein; p = 0.0015). Conclusions: Intestinal fatty acid binding protein levels
rise following infant cardiopulmonary bypass, indicating early post-operative enterocyte
injury. Intestinal fatty acid binding protein was not associated with percent of goal
enteral nutrition achieved on post-operative day 5, likely due to protocolized feeding
advancement based on clinically observable factors. Higher intestinal fatty acid binding
protein at 6 h post-operatively was independently associated with subsequent development
of necrotizing enterocolitis and may help identify patients at risk for this important
complication.
Type
Journal articleSubject
IFABPNEC
biomarker
cardiopulmonary bypass
congenital heart disease
nutrition
pediatric
post-operative care
Permalink
https://hdl.handle.net/10161/21093Published Version (Please cite this version)
10.3389/fped.2020.00267Publication Info
Watson, John D; Urban, Tracy T; Tong, Suhong S; Zenge, Jeanne; Khailova, Ludmilla;
Wischmeyer, Paul E; & Davidson, Jesse A (2020). Immediate Post-operative Enterocyte Injury, as Determined by Increased Circulating
Intestinal Fatty Acid Binding Protein, Is Associated With Subsequent Development of
Necrotizing Enterocolitis After Infant Cardiothoracic Surgery. Frontiers in pediatrics, 8. pp. 267. 10.3389/fped.2020.00267. Retrieved from https://hdl.handle.net/10161/21093.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Paul Edmund Wischmeyer
Professor of Anesthesiology
Paul Wischmeyer M.D., EDIC, FASPEN, FCCM is a critical care, perioperative, and nutrition
physician-researcher who specializes in enhancing preparation and recovery from surgery,
critical care and COVID-19. He serves as a Tenured Professor of Anesthesiology and
Surgery at Duke. He also serves as the Associate Vice Chair for Clinical Research
in the Dept. of Anesthesiology and Director of the TPN/Nutrition Team at Duke. Dr.
Wischmeyer earned his medical degree with honors at T

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