Journal
JOURNAL OF PEDIATRICS
Volume 181, Issue -, Pages 80-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jpeds.2016.10.019
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Funding
- US Food and Drug Administration [1UO1FD004194-01]
- Agency for Healthcare Research and Quality [HS000028]
- Jack and Marion Euphrat Fellowship in Pediatric Translational Medicine
- Stanford Clinical and Translational Science Award [UL1 RR025744, UL1 TR001085]
- Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health [R00HD065786]
- March of Dimes Foundation
- Stanford University School of Medicine for the March of Dimes Prematurity Research Center at Stanford [MOD PR625253]
- Stanford Child Health Research Institute
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Objective To evaluate the association between newborn acylcarnitine profiles and the subsequent development of necrotizing enterocolitis (NEC) with the use of routinely collected newborn screening data in infants born preterm. Study design A retrospective cohort study was conducted with the use of discharge records for infants born preterm admitted to neonatal intensive care units in California from 2005 to 2009 who had linked state newborn screening results. A model-development cohort of 94 110 preterm births from 2005 to 2008 was used to develop a risk-stratification model that was then applied to a validation cohort of 22 992 births from 2009. Results Fourteen acylcarnitine levels and acylcarnitine ratios were associated with increased risk of developing NEC. Each log unit increase in C5 and free carnitine /(C16 + 18: 1) was associated with a 78% and a 76% increased risk for developing NEC, respectively (OR 1.78, 95% CI 1.53-2.02, and OR 1.76, 95% CI 1.51-2.06). Six acylcarnitine levels, along with birth weight and total parenteral nutrition, identified 89.8% of newborns with NEC in the model-development cohort (area under the curve 0.898, 95% CI 0.889-0.907) and 90.8% of the newborns with NEC in the validation cohort (area under the curve 0.908, 95% CI 0.901-0.930). Conclusions Abnormal fatty acid metabolism was associated with prematurity and the development of NEC. Metabolic profiling through newborn screening may serve as an objective biologic surrogate of risk for the development of disease and thus facilitate disease-prevention strategies.
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