Prospective Cohort Study

Background Early NEC symptoms are non-specific and diagnostic tests lack discriminative power. Intes-tinal fatty acid-binding protein (I-FABP), mainly located in small bowel enterocytes, is re-leased into the blood following NEC-associated enterocyte disruption. Aim of this prospective cohort trial was to determine the diagnostic value of I-FABP measured in plas-ma (I-FABPp) and urine (I-FABPu) for the presence of NEC, to evaluate I-FABP levels dur-ing NEC development, and to assess its prognostic value for the progression from suspected to complicated disease. Methods Between 2010 and 2012 we prospectively enrolled neonates with suspected NEC. We measured I-FABP levels eight-hourly from onset of suspected NEC for at least 48 hours, or until surgery. NEC diagnosis was confirmed radiologically or during operation. We defined NEC as complicated if it resulted in surgery and/or death. We determined disease course and diagnostic I-FABP cut-off points