Date Published: January 14, 2019
Publisher: Public Library of Science
Author(s): Alena Kokesova, Stepan Coufal, Barbora Frybova, Miloslav Kverka, Michal Rygl, Camilia R. Martin.
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.
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.
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.
Urinary I-FABP reflects the mucosal damage in gastroschisis but it has only a limited predictive value for patients’ outcome.
Gastroschisis (GS) is a congenital anomaly of the abdominal wall, which results in extrusion of abdominal viscera from the abdominal cavity. The prevalence of GS is increasing; currently reaching 4.9 per 10,000 live births . Although survival in GS exceeds 90%, some babies experience significant morbidity, which is largely determined by the severity of prenatal and postnatal bowel injury .
Simple and complex GS patients have higher urinary I-FABP after the surgery than control subjects (Fig 1A and 1B). The I-FABP dynamics in simple and complex GS don’t differ. In both cases, I-FABP levels reach maximum in the first 6h after surgery (9.29 (0.59–58.56) pg/nmol for simple GS, 23.99 (16.59–41.90) pg/nmol for complex GS). Interestingly, I-FABP peaks 36 hours after the surgery in both patients with complex GS (15.57 (28.73–8.03) pg/nmol) and in controls for complex GS (4.20 (0.31–10.89) pg/nmol). The level of urinary I-FABP in controls for simple GS is generally low and without a distinct peak; in first 6 hours reaches 1.15 (0.06–3.41) pg/nmol.
Disruption of intestinal mucosa causes major complications in patients with GS. The extent of this injury and its capacity to predict patient’s recovery has not yet been sufficiently analyzed. Our study showed that I-FABP can serve as a biomarker for the gut mucosa damage after the closure of abdominal wall in GS.
Urinary I-FABP is a marker for intestinal mucosa damage in GS. Patients with complex GS have significantly higher levels of I-FABP and their recovery takes longer than in patients with simple GS. I-FABP fails to predict early MEF/FEF or shorter LOH, so it is not suitable for prediction of these parameters in clinical settings. Its capacity to predict subsequent operation for ileus in patients with complex GS needs to be interpreted with caution until a larger cohort of these patients is analyzed.