Общая реаниматология

Расширенный поиск

Inter-Alpha Inhibitor Proteins as a Predictor of Necrotizing Enterocolitis in Newborn Infants

Полный текст:


Necrotizing enterocolitis is a devastating emergency, multifactorial disease. Inter-alpha inhibitor proteins are serine protease inhibitors involved in many physiological and pathological activities.

Aim: this study was designed in order to assess the value of inter-alpha inhibitor proteins in predicting and improving accuracy of diagnosis of NEC in newborn infants with non- precise abdominal and intestinal manifestations.

Materials and Methods. This study was prospective longitudinal research that included 80 newborn infants presented with non-specific abdominal manifestations. Infants were divided into two groups. Group A; infants who developed necrotizing enterocolitis, they had stage ΙΙ or III necrotizing enterocolitis according to modified Bell’s criteria. Group B; included infants who did not develop necrotizing enterocolitis. Serum inter alpha inhibitor proteins level was measured by ELISA.

Results. In necrotizing enterocolitis group, the median inter-alpha inhibitor protein level was (9.38 mg/L), this was significantly lower than non-necrotizing enterocolitis group (44.40 mg/L), P was <0.01. Inter-alpha inhibitor protein was reduced in stage IA than stage IIIB. Inter-alpha inhibitor protein values were decreased in preterm and full term infants with sensitivity of 98 % and specificity of 96% at cutoff <19.42 and < 19.96 mg/L. The cut off in non-survival cases was >13.29 mg/L with sensitivity of 53.33 % and specificity of 92.31%.

Conclusion. Inter-alpha inhibitor protein levels were reduced in full term and preterm infants with necrotizing enterocolitis, consequently it may improve diagnosis of necrotizing enterocolitis in newborn infants. It has prognostic value and correlate with severity of necrotizing enterocolitis. It might predict non-survival cases.

Об авторах

Safaa A. ELMeneza
AL-Azhar University

Neveen M. Arafat
AL-Azhar University

Iman M. El-Bagoury
AL-Azhar University

Amal Gaber
AL-Azhar University

Список литературы

1. Yee W.H., Soraisham A.S., Shah V.S., Aziz K. , Yoon W., Lee S.K. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics 2012; 129(2): e298-e304. DOI: 10.1542/peds.2011-2022. PMID: 22271701

2. ELMeneza S. Egyptian neonatal safety standards; 2014. ENSTN/Editor: ENSTN/ISBN: 14851 Available from [accessed 15 January 2023].

3. Lim Y.P., Bendelja K., Opal S.M., Siryaporn E., Hixson D.C., Palardy J.E. Correlation between mortality and the levels of inter-alpha inhibitors in the plasma of patients with severe sepsis. J Infect Dis. 2003 ;188(6) : 919-926. DOI:10.1086/377642. PMID: 12964125

4. Kingsmore S.F., Kennedy N, Halliday H.L., Van Velkinburgh J.C., Zhong S., Gabriel V., Grant J., Beavis W.D., Tchernev VT.., Perlee L., Lejnine S., Grimwade B., Sorette M. Edgar J.D.M . Identification of diagnostic biomarkers for infection in premature neonates. Mol Cell Proteomics 2008; 7(10):1863–1875. DOI: 10.1074/mcp.M800175-MCP200. PMID: 18622029

5. Singh K., Zhang L.X., Bendelja K., Heath R., Murphy S., Sharma S., Padbury J. F., Lim, Y.-P. Inter-alpha inhibitor protein administration improves survival from neonatal sepsis in mice. Pediatr Res. 2010 ; 68(3) :242-247 . DOI: 10.1203/PDR.0b013e3181e9fdf0. PMID: 20520583

6. Walsh M.C., Kliegman R.M. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986; 33(1): 179-201. DOI: 10.1016/s0031-3955(16)34975-6. PMID: 3081865

7. Ginglen J.G., Butki N. Necrotizing enterocolitis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 30020729. Bookshelf ID: NBK5133. Available from: Necrotizing Enterocolitis - PubMed (

8. ELMeneza S., Okasha A, Abd El-Hafez M.A., Hussein N. Ischemia-modified albumin as a novel marker for diagnosis of necrotizing enterocolitis in newborn infants. J. Pediatr Neonat Individual. Med. 2021; 10(2): e100205. DOI: 10.7363/100205.

9. Puddu M, Marcialis M.A., De Magistris A., Irmesi R., Coni E., Mascia .L, Fanos V. From the “old NEC” to the “new NECs”.J Pediatr Neonat Individual Med. 2014; 3(2):e030245. DOI: 10.7363/030245

10. Chaaban H., Singh K., Huang J/, Siryaporn E., Lim Y-.P., Padbury J.F. The role of inter-alpha inhibitor proteins in the diagnosis of neonatal sepsis. J. Pediatr. 2009; 154(4):620–622. e621. DOI: 10.1016/j.jpeds.2008.10.008. PMID: 19324226

11. ELMeneza S., Amin W. Study of superior mesenteric blood velocity among normal and high risk newborn infants. Hepato-Gastroenterology. 1999; 46: SUPPL.II: 1480.; [accessed 15 January 2023].

12. Chaaban H., Shin M., Sirya E., Lim Y.-P., Caplan M., Padbury J.F. Inter-alpha inhibitor protein level in neonates predicts necrotizing enterocolitis. J Pediatr. 2010 ; 157(5): 757-761. DOI: 10.1016/j.jpeds.2010.04.075. PMID: 20955849

13. Shah B.A, Migliori A., Kurihara I., Sharma S., Lim Y.-P., Padbury J. Blood level of Inter-alpha inhibitor proteins distinguishes necrotizing enterocolitis from spontaneous intestinal perforation. J Pediatr. 2017; 180:135-140.e1. DOI: 10.1016/j.jpeds.2016.09.016. PMID: 27745748

14. Daveau M., Rouet P., Scotte M., Faye L., Hiron M., Lebreton J.P., Salier J.P. Human inter-a-inhibitor family in inflammation: simultaneous synthesis of positive and negative acute-phase proteins. Biochem. J. 1993 ; 292 (Pt 2):485-492. DOI: 10.1042/bj2920485. PMID: 7684902

15. Hirose J., Ozawa T., Miura T., Isaji M., Nagao Y., Yamashiro K., Nii A., Kato K., Uemura A. Human neutrophil elastase degrades inter-alpha-trypsin inhibitor to liberate urinary trypsin inhibitor related proteins. Biol Pharm Bull. 1998; 21(7): 651-656. doi: 10.1248/bpb.21.651. PMID: 9703243

16. Balduyck M., Albani D., Jourdain M., Mizon C., Tournoys A., Drobecq H, Fourrier F , Mizon J . Inflammation-induced systemic proteolysis of inter-alpha-inhibitor in plasma from patients with sepsis. J Lab Clin Med. 2000; 135(2): 188-198. DOI: 10.1067/mlc.2000.104462. PMID: 10695665

17. Neijens J.H., Abbink J.J., Wachtfogel Y.T., Colman R.W., Eerenberg A.J., Dors D., Kamp A.J., Strack van Schijndel R.J., Thijs L.G., Hack C.E. Plasma elastase alpha 1-antitrypsin and lactoferrin in sepsis: evidence for neutrophils as mediators in fatal sepsis. J Lab Clin Med. 1992; 119(2): 159–168. PMID: 1740629

18. Opal S.M., Lim Y.-P., Siryaporn E., Moldawer L.L, Pribble J.P., Palardy J.E., Souza S. Longitudinal studies of inter-alpha inhibitor proteins in severely septic patients: a potential clinical marker and mediator of severe sepsis. Crit Care Med. 2007; 35(2): 387-392. DOI: 10.1097/01.CCM.0000253810.08230.83. PMID: 17205024

19. Goldstein G.P., Sylvester K.G. Biomarker discovery and utility in necrotizing enterocolitis. Clin Perinatol. 2019; 46, (1): 1-17. DOI: 10.1016/j.clp.2018.10.001. PMID: 30771811

20. Agakidou E., Agakidis C., Gika H., Sarafidis K. Emerging biomarkers for prediction and early diagnosis of necrotizing enterocolitis in the era of metabolomics and proteomics. Front Pediatr. 2020; 8(8):602255. DOI: 10.3389/fped.2020.602255. PMID: 33425815


Для цитирования:

ELMeneza S.A., Arafat N.M., El-Bagoury I.M., Gaber A. Inter-Alpha Inhibitor Proteins as a Predictor of Necrotizing Enterocolitis in Newborn Infants. Общая реаниматология.

For citation:

ELMeneza S.A., Arafat N.M., El-Bagoury I.M., Gaber A. Inter-Alpha Inhibitor Proteins as a Predictor of Necrotizing Enterocolitis in Newborn Infants. General Reanimatology.

Просмотров: 90

Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.

ISSN 1813-9779 (Print)
ISSN 2411-7110 (Online)