Trends of fecal calprotectin levels and associations with early life experience in preterm infants

Wanli Xu; Yiming Zhang; Wenxiao Zhao; Jie Chen; Kendra Maas; Naveed Hussain; Wendy A Henderson; Xiaomei Cong

doi:10.1097/NR9.0000000000000006

Trends of fecal calprotectin levels and associations with early life experience in preterm infants

Interdiscip Nurs Res. 2022 Nov 23;1(1):36-42. doi: 10.1097/NR9.0000000000000006. eCollection 2022 Nov.

Authors

Wanli Xu^{1

2}, Yiming Zhang³, Wenxiao Zhao⁴, Jie Chen^{1

5}, Kendra Maas⁶, Naveed Hussain⁷, Wendy A Henderson¹, Xiaomei Cong^{1

2

8}

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
² Medical Informatics Center, Peking University, Beijing China.
³ Graduate School of Social Work, University of Denver, Denver, Colorado, USA.
⁴ School of Nursing, Shandong University of Traditional Chinese Medicine, Shandong, China.
⁵ School of Nursing, University of Maryland, Baltimore, MD, USA.
⁶ Microbial Analysis, Resources, and Services, University of Connecticut, Storrs, CT, USA.
⁷ Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, CT, USA.
⁸ School of Nursing, Yale University, Orange, CT, USA.

Abstract

Background: Preterm infants are at risk for severe infections due to their immature immune systems. Factors such as early life pain/stress experiences and feeding may influence immune activation and maturation of immune systems. However, the underlying mechanism remains unclear. Fecal calprotectin (FCP) is a noninvasive surrogate biomarker of mucosal inflammation in the gastrointestinal tract and has been used in detecting intestinal inflammation in specific pediatric gastrointestinal disorders.

Objective: To describe the longitudinal trajectory of FCP levels in preterm infants and investigate the contributing factors that are associated with FCP levels.

Design: A longitudinal study design was used.

Settings: Preterm infants were recruited from 2 neonatal intensive care units (NICU) of a children's medical center in the North-eastern US.

Methods: Preterm infants were followed during their first 4 weeks of NICU hospitalization. Stool samples were collected twice per week to quantify the FCP levels. Cumulative pain/stress experiences and feeding types were measured daily. A linear mixed-effect model was used to examine the associations between FCP levels and demographic and clinical characteristics, cumulative pain/stress, and feeding over time.

Results: Forty-nine preterm infants were included in the study. Infants' FCP levels varied largely with a mean of 268.7±261.3 µg/g and increased over time. Preterm infants experienced an average of 7.5±5.0 acute painful procedures and 15.3±20.8 hours of chronic painful procedures per day during their NICU stay. The mean percentage of mother's own milk increased from the first week (57.1±36.5%) to the fourth week (60.7±38.9%) after birth. Elevated FCP concentration was associated with acute and cumulative (chronic) pain/stress levels, mother's own milk, non-White race, and higher severity of illness score.

Conclusions: FCP levels were elevated in preterm infants with wide interindividual and intraindividual variations. Cumulative pain/stress during the NICU hospitalization, feeding, race, and health status may influence FCP concentrations in early life that may be associated with inflammatory gut processes.

Keywords: Fecal calprotectin; Gut inflammation; Pain; Preterm infant; Stress.