Calprotectin and Intestinal Fatty Acid Binding Protein (I-FABP) Level in Preterm Neonates with Necrotizing Enterocolitis

Ditya Arisanti, Satrio Wibowo, Soemarno Soemarno


Necrotizing enterocolitis (NEC) is inflammatory state of intestinal tissue which mostly occurred in preterm neonates and associated with ischemia and inflammation. This study was aimed to investigate calprotectin level (inflammatory marker) and intestinal fatty acid binding protein (I-FABP) (ischemia marker) in preterm neonates with NEC. This research was designed as cross sectional which involve 32 preterm neonates divided into 2 groups as follows: NEC group (n=16 subjects) and control group (n=16 subjects). Diagnosis of NEC was established by clinical and radiological signs (abdominal distension and pneumatosis). Fecal calprotectin and urinary I-FABP were measured using ELISA method. Results showed that fecal calprotectin and urinary I-FABP was significantly higher in NEC group as compared to control group (Mann-Whitney test, p<0.05). Both calprotectin and I-FABP was positively correlated with NEC state (Spearman correlation test, p=0.000, r=0.866). Moreover, calprotectin and I-FABP level was positively correlated with grade (Bell’s classification) and type (Gordon’s classification) of NEC (Spearman correlation test, p<0.05). We concluded that calprotectin and I-FABP level was higher in NEC group. Moreover, I-FABP but not calprotectin, were correlated with grade and type of NEC.


Calprotectin; I-FABP; Necrotizing enterocolitis; Preterm neonates

Full Text:



Ahle, M., Drott, P., Andersson R. E. 2013. Epidemiology and Trends of Necrotizing Enterocolitis in Sweden: 1987-2009. Pediatrics, 132(2), e443-51.

Albanna, E. A., Ahmed, H. S. & Awad, H. A. 2014. Stool Calprotectin in Necrotizing Enterocolitis. J. Clin. Neonatol., 3(1), 16-9.

Aydemir, O., Aydemir, C., Sarikabadayi, Y. U., Emre Canpolat, F., Erdeve, O., Biyikli, Z. & Dilmen, U. 2012. Fecal Calprotectin Levels Are Increased in Infants with Necrotizing Enterocolitis. Journal Of Maternal-Fetal and Neonatal Medicine, 25(11), 2237-2241.

Bin-Nun, A., Booms, C., Sabag, N., Mevorach, R., Algur, N., Hammerman, C. 2015. Rapid Fecal Calprotectin (FD) Analysis: Point of Care Testing for Diagnosisng Early Necrotizing Enterocolitis. Am. J. Perinatol., 32(4), 337-42.

Brooks, H., Connell, M., Broadbent, R. 2015. Microbes and the Inflammatory Response in Necrotizing Enterocolitis. Preterm Birth, 5, 137-160.

Burri, E., Beglinger, C. 2012. Faecal Calprotectin –a Useful Tool in the Management of Inflammatory Bowel Disease. Swiss Med. Wkly, 142, w13557.

Clark R. H., Gordon, P., Walker W. M., Laughon, M., Smith P. B., Spitzer A. R. 2012. Characteristics of patients who die of necrotizing enterocolitis. Journal of Perinatology, 32(3), 199–204.

Coufal, S., Kokesova, A., Tlaskalova-Hogenova, H., Snajdauf, J., Rygl, M., Kverka, M. 2016. Urinary Intestinal Fatty Acid-Binding Protein Can Distinguish Necrotizing Enterocolitis from Sepsis in Early Stage of the Disease. Journal of Immunology Research, 1, 1-8.

Evennett, N. J., Hall, N. J., Pierro, A. & Eaton, S. 2010. Urinary Intestinal Fatty Acid-Binding Protein Concentration Predicts Extent of Disease in Necrotizing Enterocolitis. J. Pediatr. Surg., 45(4), 735-40.

Gordon, P., Christensen, R., Weitkamp, J. -H. & Maheshwari, A. 2012. Mapping the New World of Necrotizing Enterocolitis (Nec): Review and Opinion. The E-Journal of Neonatology Research, 2(4), 145-172.

Gregory, K. E., Winston A. B., Yamamoto H. S., Dawood H. Y., Fashemi T., Fichorova R. N., Van Marter L. J. 2014. Urinary Intestinal Fatty Acid Binding Protein Predicts Necrotizing Enterocolitis. The Journal of Pediatrics, 164(6): 1486-1488.

Henry, M. C. & Moss, R. L. 2009. Necrotizing Enterocolitis. Annual Review of Medicine, 60, 111-124.

Maheshwari, A., Corbin, L. & Schelonka, R. 2011. Neonatal Necrotizing Enterocolitis. Res. Rep. Neonatol., 1, 39-53.

Markel, T. A., Engelstad, H. & Poindexter, B. B. 2014. Predicting Disease Severity of Necrotizing Enterocolitis: How to Identify Infants for Future Novel Therapies. J. Clin. Neonatol., 3(1), 1-9.

Neu, J. & Walker, W. A. 2011. Necrotizing Enterocolitis. New England Journal of Medicine, 364, 255-264.

Olafsdottir, E., Fluge, L. A. G., Berstad, A. 2002. Faecal Calprotectin Levels in Infants with Infantile Colic, Healthy Infants, Children with Inflammatory Bowel Disease, Children with Recurrent Abdominal Pain and Healthy Children. Acta Paediatrica, 91(1), 45-50.

Olariu, L., Olariu, G., Ognean, L. et al. 2014. Necrotizing enterocolitis in preterm infants with gestational age ≤32 weeks in Rumania: Incidence and risk factors. Jurnalul Pediatrului, 17(65/66), 36–41.

Reisinger, K. W., Kramer, B. W., Van Der Zee, D. C., Brouwers, H. A. A., Buurman, W. A., Van Heurn, E. & Derikx, J. P. M. 2014. Non-Invasive Serum Amyloid A (SAA) Measurement and Plasma Platelets for Accurate Prediction of Surgical Intervention in Severe Necrotizing Enterocolitis (Nec). PLoS One, 9(6), E90834.

Samuels, N., van de Graaf, R. A., de Jonge, R. C. J., Reiss, I. K. M., Vermeulen, M. J. 2017. Risk Factors for Necrotizing Enterocolitis in Neonates: a Systematic Review of Prognostic Studies. BMC Pediatr., 17, 105.

Schurink, M., Kooi, E. M., Hulzebos, C. V., Kox, R. G., Groen, H., Heineman, E., Bos, A. F., Hulscher, J. B. 2015. Intestinal Fatty Acid-Binding Protein as a Diagnostic Marker for Complicated and Uncomplicated Necrotizing Enterocolitis: a Prospective Cohort Study. PLoS One, 10(3), e0121336.

Selimoglu, M. A., Temel, I., Yldrm, C., Ozyaln, F., Aktas, M., Karabiber, H. 2012. The role of fecal calprotectin and lactoferrin in the diagnosis of necrotizing enterocolitis. Pediatric Critical Care Medicine 13 (4): 452–454.

Shenoy, M. T., Shenoy, K. T., Roseth, A., Geir, L., Keshavamurthy, S. R. 2014. Diagnostic Utility of Fecal Calprotectin as a Biomarker of Gut Inflammation in Neonates to Predict Necrotizing Enterocolitis: a Prospective Study. Indian J Child Health, 1(3), 99.

Sidauruk, R. J. M., Amir, I., Kadim, M., Said, M. 2014. Faktor Risiko yang Mempengaruhi Kolonisasi Mikroflora Saluran Cerna Neonatus Kurang Bulan dengan Enterokolitis Nekrotikans. Sari Pediatri. 15 (6).

Stout, G., Lambert, D. K., Baer, V. L., Gordon, P. V., Henry, E., Wiedmeier, S. E., et al. 2008. Necrotizing enterocolitis during the first week of life: a multicentered case-control and cohort comparison study. J. Perinatol., 28(8), 556-60.

Thuijls, G., Derikx, J. P., Van Wijck, K., Zimmermann, L. J., Degraeuwe, P. L., Mulder, T. L., Van Der Zee, D. C., Brouwers, H. A., Verhoeven, B. H. & Van Heurn, L. E. 2010. Non-Invasive Markers For Early Diagnosis And Determination Of The Severity of Necrotizing Enterocolitis. Annals of Surgery, 251, 1174-1180.

Yee, W. H., Soraisham, A. S., Shah, V. S., Aziz, K., Yoon, W., Lee, S. K. 2012. Incidence and Timing of Presentation of Necrotizing Enterocolitis in Preterm Infants. Pediatrics, 129(2), e298-304.

Yoon, J. M., Park, J. Y., Ko, K. O., Lim, J. W., Cheon, E. J. & Kim, H. J. 2014. Fecal Calprotectin Concentration In Neonatal Necrotizing Enterocolitis. Korean J. Pediatr., 57, 351-6.

Zvizdic, Z., Heljic, S., Firdus, A., Jonuzi, A., Zvizdic, D. 2014. Relationship of Nosocomial Infections with the Development of Necrotizing Enterocolitis in Preterm Infants. Mater Sociomed, 26, 4-6.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.