Clinical Fellow Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University Sapporo, Hokkaido, Japan
Background: Intestinal perforation (IP) is a life-threatening condition in very preterm newborns ( < 32 wks' gestation). It is caused by either focal intestinal perforation (FIP) due to muscle layer defects or necrotizing enterocolitis (NEC) associated with necrosis. In severe cases, it can lead to multiorgan failure and death. While an increase in serum IL-6 levels has been reported in infants with FIP or NEC, only a few studies have focused on changes in these levels. Objective: Here, we investigated if peak serum IL-6 levels in very preterm infants can predict the cause of IP. Design/Methods: In this single-center retrospective study, very preterm infants presenting with FIP or NEC who underwent surgical intervention at our perinatal center between January 2010 and December 2023 were studied. Diagnosis of FIP or NEC was based on histopathological findings. In cases where intestinal tissues were not collected, the diagnosis was made based solely on clinical course and intraoperative findings. Serum IL-6 levels were measured using a chemiluminescent enzyme immunoassay (Fujirebio Inc., Tokyo, Japan) or electrochemiluminescence (Cobas e 411, Roche, Mannheim, Germany) if residual blood samples were available from 24h pre- to 96h post-operatively. In addition, correlations between peri-operative peak serum IL-6 levels and the length of resected intestine in NEC cases were determined. Results: Among the 31 enrolled infants, 25 (81%) had all available data and their clinical characteristics are shown in Table 1. As shown in Figure 1 and Table 2, peri-operative peak serum IL-6 levels were lower in FIP (Fig. 1A) compared with NEC (Fig. 1B) cases. Peak serum IL-6 levels in NEC cases at 24h pre-, 0-24h, and 48-72h post-operative had a significant positive correlation with the length of resected intestine (rs=0.783, 0.932, and 0.857 respectively, Fig. 1C-F).
Conclusion(s): In very preterm infants presenting with surgical NEC cases, perioperative peak serum IL-6 levels were significantly higher compared to those with FIP. Additionally, peak 24h pre-, 0-24h, and 48-72h post-operative serum IL-6 levels showed a strong positive correlation with the length of resected NEC intestine. These findings suggest that peak serum IL-6 levels may serve not only as a biomarker for distinguishing NEC from FIP but also as an indicator of disease severity in NEC.
Changes in peri-operative peak serum IL-6 levels in intestinal perforation and correlations between peri-operative peak serum IL-6 levels and the length of resected intestine in Necrotizing enterocolitis cases
Clinical characteristics in 25 preterm infants presenting with intestinal perforation
Changes in serum IL-6 levels from 24h pre- to 96h post-operatively
