The relationship between reticulated platelets, intestinal alkaline phosphatase, and necrotizing enterocolitis

Richard Kampanatkosol, Tricia Thomson, Omar Habeeb, Loretto Glynn, Phillip J. Dechristopher, Sherri Yong, Walter Jeske, Akhil Maheshwari, Jonathan Muraskas

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background Necrotizing enterocolitis (NEC) affects up to 10% of extremely-low-birthweight infants, with a 30% mortality rate. Currently, no biomarker reliably facilitates early diagnosis. Since thrombocytopenia and bowel ischemia are consistent findings in advanced NEC, we prospectively investigated two potential biomarkers: reticulated platelets (RP) and intestinal alkaline phosphatase (iAP). Methods Infants born ≤ 32 weeks and/or ≤ 1500 g were prospectively enrolled from 2009 to 2012. Starting within 72 hours of birth, 5 weekly whole blood specimens were collected to measure RP and serum iAP. Additional specimens were obtained at NEC onset (Bell stage II or III) and 24 hours later. Dichotomous cut-points were calculated for both biomarkers. Non-parametric (Mann-Whitney) and Chi-square tests were used to test differences between groups. Differences in Kaplan-Meier curves were examined by log-rank test. The Cox proportional hazards model estimated hazard ratios. Results A total of 177 infants were enrolled in the study, 15 (8.5%) of which developed NEC (40% required surgery and 20% died). 14 (93%) NEC infants had "low" (≤ 2.3%) reticulated platelets, and 9 (60%) had "high" iAP (> 0 U/L) in at least one sample before onset. Infants with "low" RP were significantly more likely to develop NEC [HR = 11.0 (1.4-83); P = 0.02]. Infants with "high" iAP were at increased risk for NEC, although not significant [HR = 5.2 (0.7-42); P = 0.12]. Median iAP levels were significantly higher at week 4 preceding the average time to NEC onset by one week (35.7 ± 17.3 days; P = 0.02). Conclusion Decreased RP serves as a sensitive marker for NEC onset, thereby enabling early preventative strategies. iAP overexpression may signal NEC development.

Original languageEnglish (US)
Pages (from-to)273-276
Number of pages4
JournalJournal of pediatric surgery
Issue number2
StatePublished - Feb 2014
Externally publishedYes


  • Biomarker
  • Extremely-low-birthweight
  • Necrotizing enterocolitis
  • Premature

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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