Predicting intestinal recovery after necrotizing enterocolitis in preterm infants

Area of Science:

• Neonatalogy
• Gastroenterology
• Critical Care Medicine

Background:

• Necrotizing enterocolitis (NEC) poses significant challenges in predicting intestinal recovery in preterm infants.
• Early identification of recovery is crucial for optimizing clinical management and improving outcomes.

Purpose of the Study:

• To evaluate the predictive value of specific biomarkers for intestinal recovery in preterm infants following NEC.
• To determine if intestinal tissue oxygen saturation (r_intSO₂) and urinary intestinal-fatty acid binding protein (I-FABP_u) can predict recovery and complications.

Main Methods:

• Measured r_intSO₂ and I-FABP_u levels at specific time points after NEC onset and before/after re-feeding.
• Assessed intestinal recovery based on time to full enteral feeding (FEFt) and development of post-NEC complications (recurrent NEC, stricture).
• Compared biomarker levels and ranges between infants with different recovery trajectories and complications.

Main Results:

• Biomarkers predicted intestinal recovery only after the first re-feed.
• Mean r_intSO₂ ≥ 53% and r_intSO₂ range ≥ 50% predicted faster FEFt (<14 days) with an odds ratio of 16.7.
• A smaller r_intSO₂ range and higher I-FABP_u were associated with post-NEC stricture, but not recurrent NEC.

Conclusions:

• r_intSO₂, its range, and I-FABP_u measured after the first re-feed are valuable predictors of intestinal recovery post-NEC.
• These biomarkers may aid in individualizing feeding regimens for preterm infants recovering from NEC.
• Further research can validate these findings for clinical application in NEC management.