Evaluation of Plasma D-Lactate Level in Preterm Infants in Necrotizing Enterocolitis

Abstract Background Necrotizing enterocolitis (NEC) is a severe and potentially lethal intestinal disease that occurs almost exclusively in preterm infants. Currently, the diagnosis of NEC is based on clinical and radiographic findings. Utilization of non-invasive biomarkers for early diagnosis is the preferred attitude in most of the diseases. Aim of the Work Measure plasma D-lactate levels in preterm infants diagnosed with NEC in comparison to age-matched controls and also to correlate these levels to severity of intestinal ischemia in these cases. Patients and Methods The current study included 30 preterm neonates diagnosed with NEC and 30 preterm neonates who were admitted into NICU (Neonatal intensive care unit) due to other cause rather than NEC (as a control group)., All the cases underwent full history taking, full general examination and full local regional examination(measurement of abdominal girth, intestinal sounds, passage of stool, gastric residual, abdominal tenderness). The laboratory (Hemoglobin level, platlets count, white blood cells count, plasma D-lactate level) and the radiological investigations (Abdominal erect xray) were also conducted. Lactate level was measured at two occasions (on admission and after one week) The cases were followed up to determine the outcome (the mortality). Results The D-lactate level (at first sample at onset NEC) in the NEC group was statistically significantly higher as compared to the control group (p < 0.001); median (IQR) : 7.11 (6.79 – 11.82) versus 4.11 (1.99 – 4.96)]. The level of plasma D lactate showed a statistically significant decrease between first and second sample(After one week) in discharged patients with no statistically significant change in died patients. The best cutoff point of D-lactatein the first reading to identify cases with NEC was > 5.45 mmol/L with diagnostic sensitivity 100%, specificity 100% and accuracy 100%. Conclusion The use of plasma D-lactate levels as a marker of intestinal injury could be useful as a diagnostic indicator in the early stage of NEC. Moreover, d-lactate can be correlated with the severity of NEC.