Role of calprotectin in diagnosis of necrotizing enterocolitis and Doppler US in detecting its severity and outcome in neonates

Abstract

Background

Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal emergency in preterm neonates, with mortality exceeding 50% in severe cases. Early diagnosis remains challenging due to nonspecific clinical signs.

Objectives

This study aimed to evaluate the diagnostic accuracy of fecal calprotectin (FCP) and assess Doppler ultrasound (US) for predicting disease severity and mortality.

Methods

A case-control study of 54 neonates with NEC (Bell’s Stages I–III) and 42 matched controls. FCP levels were measured within 48 hours of symptom onset and Doppler US was performed to evaluate bowel perfusion. It was done at Neonatal Intensive Care Unit (NICU) during the period from (January 2019 to December 2019).

Results

Fecal calprotectin levels were significantly higher in NEC cases (362.6 ± 239.8 µg/g) compared to controls (61.9 ± 44.2 µg/g, p < 0.001). The optimal FCP cutoff was 176 µg/g (sensitivity 87%, specificity 97.6%). Doppler US showed decreased bowel perfusion in 77.8% of Stage III NEC cases, which strongly predicted mortality (OR 4.2, 95% CI 1.8–9.6).

Conclusion

FCP and Doppler US provide complementary, non-invasive methods for early NEC diagnosis and risk stratification. Their combined use could improve clinical decision-making in high-risk neonates.