Platelet-activating factor in infants at risk for necrotizing enterocolitis

Background: Platelet-activating factor (PAF) is a heterogeneous phospholipi d that has been implicated as participating in a number of perinatal diseas e processes including necrotizing enterocolitis (NEC). Methods: Baseline blood levels of PAF and related lipids (PAF-LL) were meas ured for 164 infants at risk for NEC from 3 neonatal intensive care units. Serial levels were obtained from the 11 infants in whom NEC developed. Results: The mean peak PAF-LL in the infants without NEC was 2.03 +/- 1.96 ng/mL. Infants with stage II (n = 6) and III (n = 5) NEC had elevated peak PAF-LL values (mean peak value 13.6 +/- 6.9 ng/mL). No PAF-LT, measurements obtained from infants during stage II or III NEC were <2.03 ng/mL. Three i nfants had PAF-LL elevations before the development of any clinical or radi ographic evidence of NEC. PAF-LL level increased as the severity of NEC inc reased and decreased with its resolution. Setting a PAF-LL level of 10.2 ng /mL as a cutoff for NEC had a positive predictive value of 100%. Conclusions: PAF-LL determinations can complement clinical and radiographic studies to diagnose and follow the progression of NEC. PAF-LL may have a r ole in the evolution of NEC.