| Background: Platelet selectin (P-selectin), an adhesion molecule expressed
by activated endothelial cells, mediates the early phases of leukocyte
adherence to the endothelium. Expression of P-selectin has been shown to
be crucial to neutrophil recruitment in many human inflammatory processes
as well as in animal models of intestinal ischemia-reperfusion, intestinal
transplantation, and sepsis, but its role in NEC is unknown. Objective: To
study P-selectin, a possible cause of NEC, in the blood of preterm infants.
Study design: Twenty-four consecutive preterms, clinically suspected or
proven to have NEC, were enrolled in this pilot study. Their weight ranged
from 1 to 2.3 Kg (mean ±SD: 1.7±0.5 Kg), age ranged from 2 to 21 days
(mean ±SD: 12±3.5 days) and their gestational age (GA) ranged from 29 to
33 weeks (mean ±SD: 31±3 weeks). In addition, 12 age- and weight-matched
apparently healthy preterm infants served as a control group. Written
consents were obtained from the parents of infants included in the study. All
neonates were subjected to perinatal history, clinical examination, routine
investigations (CBC, plain X-ray and abdominal ultrasonography (US),
arterial blood gases and serum bicarbonate, serum sodium, CRP and blood
culture), and measurement of blood P-selectin by direct immunofluorescent
staining. Results: Infants with NEC clinically presented with significant
PROM, gastric residual, abdominal distensions, hypoperfusion,
hematochezia and evidence of NEC in abdominal X-ray and/or US,
compared to control infants. Significant abnormal laboratory investigations
in NEC cases included high CRP, hyponatremia, bandemia,
thrombocytopenia, metabolic acidosis, and blood culture-proven neonatal
sepsis. Abnormal blood P-selectin (>20 units) was detected in 21 (87.5%)
infants with NEC, with a mean level of 51±12.4 units that was significantly
higher than that of control infants, P<0.001. A strong significant negative
correlation was observed between blood P-selectin and each of GA, body
weight, platelet count, arterial blood pH and bicarbonate, while it was a
significant positive correlation with each of CRP and band cell count.
Conclusion: P-selectin may have a role in the pathogenesis of NEC in
preterm infants and may be used as a diagnostic tool. |