Serum Claudin 2 as an Early Marker for Necrotizing Enterocolitis in Preterm Neonates

Background: Necrotizing enterocolitis (NEC) is a gastrointestinal emergency and is associated with significant morbidity and mortality. early diagnosis of NEC is essential. Claudins are transmembrane proteins, which are part of intestinal epithelial tight junctions by binding to the actin cytoskeleton. Claudin-2 present in the blood is considered as a useful biomarker of intestinal permeability. 
Aim of the Work: To measure the level of serum Claudin-2 in preterm neonates with Necrotizing Enterocolitis (NEC) in comparison to control group and correlate the level of serum Claudin-2 with the disease severity.
Patients and Methods: A case control study was conducted over three groups of preterm neonates.  Cases group included 26 preterm neonates less than 32 weeks diagnosed with NEC by clinical ,laboratory and radiological evaluation . 26 preterm neonates were included as matching control group (age and sex).15 preterm neonates were included as feeding intolerance group. Detailed history and clinical assessment were done.  Radiological investigations in the form of US and abdominal x-ray were done to diagnosis NEC according to bell’s stage. Routine laboratory investigations were done in the form of CBC, CRP and blood culture. Specific lab was done in the form of measuring serum claudin-2 by Sandwich Elisa.
Results: There was a significant decrease of the platelets count in cases group and feeding intolerance group in comparison to control group with P value 0.006 and p value 0.000 respectively. There was a significant increase in serum claudin-2 in cases group and feeding intolerance group in comparison to control group with P value 0.00 and P value 0.00 respectively. Serum claudine-2 for detecting NEC show cut off value > 1.5 ng/dl, sensitivity was 100 % and specificity was 96.15%. Also, serum claudin-2 level is increased with increase the severity of the disease.
Conclusion: Serum claudin-2 is a novel promising biomarker and tool for early detection and valuable asset to facilitate early intervention and potential prevention of severe NEC. Preliminary findings indicate that serum claudin-2 may represent a potential biomarker for NEC.