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Updated: Jul 16, 2026
Microfluidic Model of Necrotizing Enterocolitis Incorporating Human Neonatal Intestinal Enteroids and a Dysbiotic Microbiome
Published on: July 28, 2023
Low levels of procalcitonin during episodes of necrotizing enterocolitis
Dan Turner1, Cathy Hammerman, Bernard Rudensky
1Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel. dan.turner@sickkids.ca
Abstract:
The pathogenesis of necrotizing enterocolitis (NEC) remains poorly understood. We aimed to assess the extent of bacterial infection in the pathogenesis of NEC using serial procalcitonin measurements. Blood samples were drawn during the first 4 days following every clinical event requiring a workup for presumed NEC. Eight episodes were confirmed as NEC, 7 of which showed procalcitonin levels <1 ng/ml at presentation and <1.3 ng/ml thereafter, comparable to 24 healthy controls. The one infant with elevated procalcitonin had bacteremia in addition to NEC. Procalcitonin levels of 24 matched septic infants were higher than those of NEC infants, peaking at 4.1 ng/ml. We conclude that low procalcitonin values are the rule during episodes of NEC and provide further evidence that overactive local immune response, and not active infection, is primarily responsible for the mucosal damage in NEC.
Insights
Necrotizing enterocolitis (NEC) pathogenesis is unclear. Low procalcitonin levels in NEC infants suggest local immune response, not bacterial infection, causes mucosal damage.
Area of Science:
- Neonatal research
- Gastroenterology
- Immunology
Background:
- Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease in neonates.
- The exact cause of NEC pathogenesis is not fully understood.
- Bacterial infection is a suspected contributor to NEC.
Purpose of the Study:
- To investigate the role of bacterial infection in NEC pathogenesis.
- To evaluate procalcitonin levels as a biomarker for infection in NEC.
- To differentiate between infection and immune response in NEC.
Main Methods:
- Serial procalcitonin measurements in infants with suspected NEC.
- Comparison of procalcitonin levels in NEC infants, healthy controls, and septic infants.
- Analysis of procalcitonin levels in relation to clinical events and bacteremia.
Main Results:
- Seven out of eight confirmed NEC cases had low procalcitonin levels (<1 ng/ml at presentation).
- One NEC infant with elevated procalcitonin also had bacteremia.
- Procalcitonin levels in septic infants were significantly higher than in NEC infants.
Conclusions:
- Low procalcitonin levels are characteristic of NEC episodes.
- Findings suggest an overactive local immune response, rather than active bacterial infection, is the primary driver of NEC mucosal damage.
- Procalcitonin may help differentiate NEC from sepsis in neonates.
