Predictors of Neonatal Necrotizing Enterocolitis
Condition: Necrotising Enterocolitis
MeSH terms: Enterocolitis; Enterocolitis, Necrotizing
Study type: Observational

Summary: 
      To assess the value of peripheral blood neutrophil to lymphocyte ratio (NLR), serum levels of
      γ-Glutamyl transferase (GGT), total serum bilirubin and serum calcium (Ca2+) concentrations
      for early diagnosis and prediction of NEC severity and if found significant, scoring will be
      done according to their levels in different Bell's stages.
    

Detailed description: 
      Necrotizing enterocolitis (NEC) is primarily a disease process of the gastrointestinal tract
      of neonates that results in inflammation and bacterial invasion of the bowel wall.

      Despite extensive research, the pathophysiology of NEC remains unclear and therapeutic
      options are limited.

      Clinical manifestations of NEC may be vague, including increased episodes of apnea,
      desaturations, bradycardia, lethargy and temperature instability.

      There may also be GI-specific symptoms such as feeding intolerance, emesis, bloody stools,
      abdominal distention and tenderness, and abdominal wall discoloration.

      Radiographic signs may include ileus, dilated or fixed intestinal loops, air in the
      intestinal wall or free air in the abdomen.

      NEC diagnosis, however, remains challenging because many now see that Bell's staging criteria
      currently used for diagnosis as being not accurate.

      Neutrophil to lymphocyte ratio (NLR) is used as a marker of subclinical inflammation. It is
      calculated by dividing the number of neutrophils by number of lymphocytes, usually from
      peripheral blood sample. Increase of neutrophil proportion just reflects the deterioration of
      the immune system, while decreased lymphocyte ratio reflects the increasing level of physical
      stress.

      Further NLR is closely related to the inhibition of body's immune function. In a word, NLR
      could indicate the status of body's inflammation response and the level of physical stress
      timely and accurately.

      In a clinical study conducted in 2001, the authors suggested the routine use of NLR as a
      stress factor in clinical ICU practice, and they claimed that NLR might has a prognostic and
      a predictive value of many diseases.

      Gamma glutamyl transferase (GGT) is an enzyme found in the cell membranes of many tissues.
      The highest concentration is in the kidney, but the liver is considered the source of normal
      enzyme activity. GGT is involved in the transfer of amino acids across the cell membrane and
      also in leukotriene metabolism. It has an intracellular antioxidant effect because it is
      involved in glutathione metabolism, resulting in the formation of cysteine. GGT is cleared
      from the plasma by liver uptake.

      Bilirubin is a free radical scavenger with anti-inflammatory and antioxidant property. One
      report described that stage III NEC had lower total serum bilirubin than their mild or
      disease-free controls during the first 14 days of life. Since serum bilirubin level is a
      function of the activity of UGT1A1, albumin binding, and the bilirubin load; it will be
      important to determine if serum bilirubin concentration correlates with NEC development or
      severity.

      A relatively constant serum calcium (Ca2+) concentration is vital for cellular function and
      under strict control by the neural/humoral factors. It is unclear what causes serum Ca2+
      lower in NEC neonates. In a recent report, higher level of serum GGT, a significantly lower
      serum bilirubin and Ca2+ were found in severe NEC.
    

Intervention name(s): Serum γ-Glutamyl transferase (GGT), Total serum bilirubin (TSB), Serum calcium concentration (Ca2+), Peripheral blood neutrophil to lymphocyte ratio (NLR)
Intervention type(s): Diagnostic Test
Intervention description(s): GGT, Ca2+, NLR and TSB are serum markers which had been studied for early detection and prediction of severity of NEC.
Intervention MeSH terms: Calcium; Bilirubin
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Neonates with gestational ages are between 28-36 weeks regardless of birth weight.