THE NECESSITY FOR T-CRYPTANTIGEN ACTIVATION SCREENING IN BABIES WITH NECROTIZING ENTEROCOLITIS

Objective. To determine the prevalence of T-cryptantigen activation (T CA) and its predictive value for severity of necrotising enterocolitis (NEC) in babies. Study design. Prospective descriptive. Study populat ion. Thirty-four babies with NEC were prospectively screened for TCA a t Tygerberg Hospital over a 6-month period, TCA screening was done by testing for red blood cell agglutination by the common peanut lectin, Arachis hypogea, Once TCA was confirmed, only washed red cells were ad ministered to the babies and plasma-containing blood products were avo ided. NEC was divided into suspected NEC (stage 1), classic NEC (stage 2) and fulminant NEC (stage 3). Main outcome measures. Prevalence of TCA in babies with various stages of NEC; the association between TCA and bowel necrosis, need for surgery acid mortality. Results. TCA was positive in 8 (24%) of the babies in this study. Six babies (18%) had stage 1 NEC, 10 (29%) had stage 2 NEC and 18 (53%) had fulminating or stage 3 NEC. All 18 babies with stage 3 NEG required surgery and TCA w as present in 8 (47%) of them. Twelve babies (35%) died, 3 with TCA an d 9 with no TCA. Babies with TCA had portal venous gas on abdominal ra diographs (P = 0.037) and stage 3 NEG (P = 0.003) more often than babi es with no TCA. Conclusions. A strong association was noted between TC A and the fulminant form of NEC with bowel necrosis. TCA in a baby wit h NEC should alert the surgeon to the possibility of severe disease an d the need to avoid plasma-containing blood products. Blood banks are urged to introduce routine screening for TCA in all babies with NEC.