Inter-Alpha Inhibitor Protein Level in Neonates Predicts Necrotizing Enterocolitis

Objectives To compare inter-alpha inhibitor protein (IaIp) levels in neonates with proven necrotizing enterocolitis (NEC) and neonates with other, nonspecific abdominal disorders. Study design This was a prospective observational study of neonates in the neonatal intensive care unit. NEC was diagnosed according to Bell's staging criteria. The nNeonates in the control group had a nonspecific abdominal disorder, but no radiographic evidence of NEC and no disease progression. All neonates with radio-graphically confirmed NEC were included. Plasma IaIp levels were quantitated by enzyme-linked immunosorbent assay. Results Seventeen neonates had confirmed NEC, and 34 neonates had nonspecific abdominal disorders that improved rapidly. Gestational age, postnatal age, weight, sex, maternal obstetric variables, rupture of membranes, and mode of delivery did not differ between the two groups. Mean IaIp level was significantly lower in the NEC group compared with the control group (137 +/- 38 mg/L; 95% confidence interval [CI], 118-157 mg/L vs 258 +/- 53 mg/L; 95% CI, 238-277 mg/L; P <. 0001). Conclusions The finding of significantly lower IaIp levels in neonates with NEC suggests that IaIp might be a useful, sensitive biomarker, allowing initiation of appropriate therapy and reducing antibiotic overuse in neonates with suspected but unproven NEC. Administration of IaIp may significantly reduce the severity of systemic inflammation and associated tissue injury. (J Pediatr 2010; 157:757-61).