BACKGROUND/PURPOSE: We analyzed the capacity of urinary Intestinal fatty acid-binding protein (I-FABP) to quantify the degree of mucosal injury in neonates with gastroschisis (GS) and to predict the speed of their clinical recovery after surgery. METHODS: In this prospective study, we collected urine during the first 48h after surgery from neonates operated between 2012 and 2015 for GS. Neonates with surgery that did not include gut mucosa served as controls for simple GS and neonates with surgery for intestinal atresia served as control for complex GS patients. The I-FABP levels were analyzed by ELISA. RESULTS: Urinary I-FABP after the surgery is significantly higher in GS newborns than in control group; I-FABP in complex GS is higher than in simple GS. I-FABP can predict subsequent operation for ileus in patients with complex GS. Both ways of abdominal wall closure (i.e. primary closure and stepwise reconstruction) led to similar levels of I-FABP. None of the static I-FABP values was useful for the outcome prediction. The steep decrease in I-FABP after the surgery is associated with faster recovery, but it cannot predict early start of minimal enteral feeding, full enteral feeding or length of hospitalization. CONCLUSION: Urinary I-FABP reflects the mucosal damage in gastroschisis but it has only a limited predictive value for patients' outcome.

Department of Pediatric Surgery Charles University Prague 2nd Faculty of Medicine University Hospital Motol Prague Prague Czech Republic

The Czech Academy of Sciences Institute of Experimental Medicine Prague Czech Republic

The Czech Academy of Sciences Institute of Microbiology Prague Czech Republic

Zobrazit více v PubMed

Jones AM, Isenburg J, Salemi JL, Arnold KE, Mai CT, Aggarwal D, et al. Increasing Prevalence of Gastroschisis—14 States, 1995–2012. MMWR Morb Mortal Wkly Rep. 2016;65(2):23–6. 10.15585/mmwr.mm6502a2 . PubMed DOI

Skarsgard ED. Management of gastroschisis. Curr Opin Pediatr. 2016;28(3):363–9. 10.1097/MOP.0000000000000336 . PubMed DOI

Langer JC, Longaker MT, Crombleholme TM, Bond SJ, Finkbeiner WE, Rudolph CA, et al. Etiology of intestinal damage in gastroschisis. I: Effects of amniotic fluid exposure and bowel constriction in a fetal lamb model. J Pediatr Surg. 1989;24(10):992–7. . PubMed

Grootjans J, Lenaerts K, Buurman WA, Dejong CH, Derikx JP. Life and death at the mucosal-luminal interface: New perspectives on human intestinal ischemia-reperfusion. World J Gastroenterol. 2016;22(9):2760–70. 10.3748/wjg.v22.i9.2760 PubMed DOI PMC

Adriaanse MP, Tack GJ, Passos VL, Damoiseaux JG, Schreurs MW, van Wijck K, et al. Serum I-FABP as marker for enterocyte damage in coeliac disease and its relation to villous atrophy and circulating autoantibodies. Aliment Pharmacol Ther. 2013;37(4):482–90. 10.1111/apt.12194 . PubMed DOI

Sarikaya M, Ergul B, Dogan Z, Filik L, Can M, Arslan L. Intestinal fatty acid binding protein (I-FABP) as a promising test for Crohn's disease: a preliminary study. Clin Lab. 2015;61(1–2):87–91. . PubMed

Coufal S, Kokesova A, Tlaskalova-Hogenova H, Snajdauf J, Rygl M, Kverka M. Urinary Intestinal Fatty Acid-Binding Protein Can Distinguish Necrotizing Enterocolitis from Sepsis in Early Stage of the Disease. J Immunol Res. 2016;2016:5727312 10.1155/2016/5727312 PubMed DOI PMC

Bingold TM, Franck K, Holzer K, Zacharowski K, Bechstein WO, Wissing H, et al. Intestinal Fatty Acid Binding Protein: A Sensitive Marker in Abdominal Surgery and Abdominal Infection. Surg Infect (Larchmt). 2015;16(3):247–53. 10.1089/sur.2014.073 . PubMed DOI

Derikx JP, Evennett NJ, Degraeuwe PL, Mulder TL, van Bijnen AA, van Heurn LW, et al. Urine based detection of intestinal mucosal cell damage in neonates with suspected necrotising enterocolitis. Gut. 2007;56(10):1473–5. 10.1136/gut.2007.128934 PubMed DOI PMC

Molik KA, Gingalewski CA, West KW, Rescorla FJ, Scherer LR, Engum SA, et al. Gastroschisis: a plea for risk categorization. J Pediatr Surg. 2001;36(1):51–5. 10.1053/jpsu.2001.20004 . PubMed DOI

Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R, Parenteral Nutrition Guidelines Working G, et al. 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005;41 Suppl 2:S1–87. . PubMed

Ockner RK, Manning JA. Fatty acid-binding protein in small intestine. Identification, isolation, and evidence for its role in cellular fatty acid transport. J Clin Invest. 1974;54(2):326–38. 10.1172/JCI107768 PubMed DOI PMC

Gollin G, Marks WH. Elevation of circulating intestinal fatty acid binding protein in a luminal contents-initiated model of NEC. J Pediatr Surg. 1993;28(3):367–70; discussion 70–1. . PubMed

Lieberman JM, Sacchettini J, Marks C, Marks WH. Human intestinal fatty acid binding protein: report of an assay with studies in normal volunteers and intestinal ischemia. Surgery. 1997;121(3):335–42. . PubMed

Thuijls G, van Wijck K, Grootjans J, Derikx JP, van Bijnen AA, Heineman E, et al. Early diagnosis of intestinal ischemia using urinary and plasma fatty acid binding proteins. Ann Surg. 2011;253(2):303–8. 10.1097/SLA.0b013e318207a767 . PubMed DOI

Edelson MB, Sonnino RE, Bagwell CE, Lieberman JM, Marks WH, Rozycki HJ. Plasma intestinal fatty acid binding protein in neonates with necrotizing enterocolitis: a pilot study. J Pediatr Surg. 1999;34(10):1453–7. . PubMed

Kunz SN, Tieder JS, Whitlock K, Jackson JC, Avansino JR. Primary fascial closure versus staged closure with silo in patients with gastroschisis: a meta-analysis. J Pediatr Surg. 2013;48(4):845–57. 10.1016/j.jpedsurg.2013.01.020 PubMed DOI PMC

Christison-Lagay ER, Kelleher CM, Langer JC. Neonatal abdominal wall defects. Semin Fetal Neonatal Med. 2011;16(3):164–72. 10.1016/j.siny.2011.02.003 . PubMed DOI

Caglar M, Karaguzel G, Gokhan-Ocak G, Yasar D, Berker-Karauzum S, Gelen T, et al. Multidirectional and simultaneous evaluation of gastroschisis-related intestinal damage in chick embryos. J Pediatr Surg. 2014;49(11):1577–84. 10.1016/j.jpedsurg.2014.06.019 . PubMed DOI

Eleftheriadis E, Kotzampassi K, Papanotas K, Heliadis N, Sarris K. Gut ischemia, oxidative stress, and bacterial translocation in elevated abdominal pressure in rats. World J Surg. 1996;20(1):11–6. . PubMed

Aina-Mumuney AJ, Fischer AC, Blakemore KJ, Crino JP, Costigan K, Swenson K, et al. A dilated fetal stomach predicts a complicated postnatal course in cases of prenatally diagnosed gastroschisis. Am J Obstet Gynecol. 2004;190(5):1326–30. 10.1016/j.ajog.2003.11.003 . PubMed DOI

Huh NG, Hirose S, Goldstein RB. Prenatal intraabdominal bowel dilation is associated with postnatal gastrointestinal complications in fetuses with gastroschisis. Am J Obstet Gynecol. 2010;202(4):396 e1–6. 10.1016/j.ajog.2009.10.888 . PubMed DOI

Stuber TN, Frieauff E, Weiss C, Zollner U, Wockel A, Meyer T, et al. Prenatal sonographic ultrasound predictors for the outcome in fetal gastroschisis: a retrospective analysis. Arch Gynecol Obstet. 2016;293(5):1001–6. 10.1007/s00404-015-3936-2 . PubMed DOI

Janoo J, Cunningham M, Hobbs GR, O'Bringer A, Merzouk M. Can antenatal ultrasounds help predict postnatal outcomes in babies born with gastrochisis? The West Virginia experience. W V Med J. 2013;109(2):22–7. . PubMed

Kuleva M, Khen-Dunlop N, Dumez Y, Ville Y, Salomon LJ. Is complex gastroschisis predictable by prenatal ultrasound? BJOG. 2012;119(1):102–9. 10.1111/j.1471-0528.2011.03183.x . PubMed DOI

Frybova B, Vlk R, Kokesova A, Rygl M. Isolated prenatal ultrasound findings predict the postnatal course in gastroschisis. Pediatr Surg Int. 2015;31(4):381–7. 10.1007/s00383-015-3675-2 . PubMed DOI

Olesevich M, Alexander F, Khan M, Cotman K. Gastroschisis revisited: role of intraoperative measurement of abdominal pressure. J Pediatr Surg. 2005;40(5):789–92. 10.1016/j.jpedsurg.2005.01.043 . PubMed DOI

Serum TGF-β1 and CD14 Predicts Response to Anti-TNF-α Therapy in IBD

Urinary I-FABP, L-FABP, TFF-3, and SAA Can Diagnose and Predict the Disease Course in Necrotizing Enterocolitis at the Early Stage of Disease

Inflammatory Bowel Disease Types Differ in Markers of Inflammation, Gut Barrier and in Specific Anti-Bacterial Response