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Fecal Calprotectin in Very Low Birth Weight Infants

Josefsson, Stina*; Bunn, Susan K; Domellöf, Magnus*

Journal of Pediatric Gastroenterology & Nutrition: April 2007 - Volume 44 - Issue 4 - p 407–413
doi: 10.1097/MPG.0b013e3180320643
Original Articles: Gastroenterology

Objectives: To measure concentrations of fecal calprotectin (f-calprotectin) in infants with very low birth weight (VLBW; <1500 g) longitudinally and to describe changes in f-calprotectin in infants who develop severe abdominal disease.

Patients and Methods: The study included 59 VLBW infants. Seven patients (disease group) developed severe abdominal disease defined as necrotizing enterocolitis (NEC) or a condition leading to laparotomy. The remainder (n = 52) were considered reference infants and had a mean (±SD) gestational age of 27.2 ± 2.6 weeks and a birth weight of 939 ± 273 g. F-calprotectin was analyzed in meconium and weekly during postnatal weeks 1 to 8. In disease cases, more frequent samples were analyzed around the time of abdominal disease diagnosis.

Results: In reference infants the median (range) f-calprotectin level in meconium was 332 (12–9386) μg/g and correlated negatively to Apgar score. F-calprotectin in postmeconium samples was 253 (9–1867) μg/g and correlated positively to delivery by cesarean section, postnatal age, and volume of enteral feeds, and negatively to treatment with antibiotics and corticosteroids. In reference infants no postmeconium sample had f-calprotectin levels >2000 μg/g. In disease cases f-calprotectin was increased to >2000 μg/g in 3 cases of NEC and 1 case of covered perforation with microscopic bowel inflammation. In 1 case of NEC without microscopic bowel inflammation and 2 cases of focal intestinal perforation, f-calprotectin levels never exceeded 2000 μg/g.

Conclusions: F-calprotectin concentrations in VLBW infants are similar to previously reported levels in healthy term and moderately preterm infants. An f-calprotectin level >2000 μg/g is a useful but not an early marker of NEC and other severe intestinal inflammatory conditions in VLBW infants.

*Department of Clinical Sciences, Paediatrics, Umeå University Hospital, Umeå, Sweden

Department of Paediatric Gastroenterology, Royal Victoria Hospital, Newcastle Upon Tyne, UK

Received 3 March, 2006

Accepted 3 October, 2006

Address correspondence and reprint requests to Magnus Domellöf, Department of Clinical Sciences, Paediatrics, Umeå University Hospital, SE-90185 Umeå, Sweden (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.