T and Tk antigen activation in necrotising enterocolitis: manifestations, severity of illness, and effectiveness of testing
a Department of
Neonatology, Westmead Hospital, Westmead,
Australia, b School of Paediatrics, University of New
South Wales, Sydney, Australia, c The Blood Transfusion Laboratory, Westmead
Hospital, Westmead, Australia
Correspondence to: Dr Kei Lui Director, Department of Newborn Care, Royal Hospital for Women Barker Street, Randwick, NSW Australia, 2031 Email: k.lui{at}unsw.edu.au
Accepted 6 November
1998
AIMS
To
determine if T or Tk antigen activation is associated with different
and more severe manifestations of illness in infants with necrotising
enterocolitis (NEC); and if a policy of testing infants with suspected
sepsis or NEC for T and Tk antigen activation is effective.
METHODSA
case-control study of infants with confirmed NEC, born after the
introduction of screening, was undertaken:17 activated infants were
compared with 28 non-activated controls, matched for gestation and
weight. A historical control study compared the outcome of infants
before and after the introduction of testing.
RESULTSOf 201 infants with confirmed NEC, 27 were T or Tk antigen activated10 (9%)
before and 17 (19%) after the introduction of testing. T or Tk antigen
activated infants had a significantly higher mortality (35%
vs 7%); more frequent (71%
vs 21%) and severe haemolysis,
hyperkalaemia, renal impairment, acidosis; and they received more
colloid for resuscitation. While only known activated infants in both
time periods were managed with the use of low titre T antibody blood
products, there was a significant increase in mortality (odds ratios
2.6; 95% CI 1.2, 5.6) and incidence of surgery (OR 2.7; 1.5, 4.9)
after the introduction of testing. The increased mortality (OR 2.6;
0.8, 5.2) and incidence of surgery (OR 1.8; 0.9, 3.7) were no longer
significant after adjustment for several perinatal risk factors.
CONCLUSIONSIn
a retrospective case-control study, routine testing of at risk infants
increased the detection rate of T and Tk antigen activation. The use of
low titre T plasma products in these patients did not reduce mortality
compared with historical controls. A randomised controlled trial of
testing in at risk infants, or of the use of low titre T plasma
products in babies with NEC and T activation, is warranted.
Keywords: necrotising enterocolitis; polyagglutination; T antigen; Tk antigen
© 1999 by Archives of Disease in Childhood
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