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Predicting intestinal recovery after necrotizing enterocolitis in preterm infants
Sara J Kuik1, Willemien S Kalteren2, Mirthe J Mebius2
1Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. s.j.kuik@umcg.nl.
Insights
Predicting intestinal recovery in preterm infants after necrotizing enterocolitis (NEC) is challenging. Biomarkers like tissue oxygen saturation and urinary intestinal-fatty acid binding protein levels show promise for guiding feeding strategies post-NEC.
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 (rintSO2) and urinary intestinal-fatty acid binding protein (I-FABPu) can predict recovery and complications.
Main Methods:
- Measured rintSO2 and I-FABPu 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 rintSO2 ≥ 53% and rintSO2 range ≥ 50% predicted faster FEFt (<14 days) with an odds ratio of 16.7.
- A smaller rintSO2 range and higher I-FABPu were associated with post-NEC stricture, but not recurrent NEC.
Conclusions:
- rintSO2, its range, and I-FABPu 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.
Background:
Intestinal recovery after NEC is difficult to predict in individuals. We evaluated whether several biomarkers predict intestinal recovery after NEC in preterm infants.
Methods:
We measured intestinal tissue oxygen saturation (rintSO2) and collected urinary intestinal-fatty acid binding protein (I-FABPu) levels 0-24 h and 24-48 h after NEC onset, and before and after the first re-feed. We assessed intestinal recovery in two ways: time to full enteral feeding (FEFt; below or equal/above group's median) and development of post-NEC complications (recurrent NEC/post-NEC stricture). We determined whether the rintSO2, its range, and I-FABPu differed between groups.
Results:
We included 27 preterm infants who survived NEC (Bell's stage ≥ 2). Median FEFt was 14 [IQR: 12-23] days. Biomarkers only predicted intestinal recovery after the first re-feed. Mean rintSO2 ≥ 53% combined with mean rintSO2range ≥ 50% predicted FEFt < 14 days with OR 16.7 (CI: 2.3-122.2). The rintSO2range was smaller (33% vs. 51%, p < 0.01) and I-FABPu was higher (92.4 vs. 25.5 ng/mL, p = 0.03) in case of post-NEC stricture, but not different in case of recurrent NEC, compared with infants without complications.
Conclusion:
The rintSO2, its range, and I-FABPu after the first re-feed after NEC predicted intestinal recovery. These biomarkers have potential value in individualizing feeding regimens after NEC.
