Dried blood spots-based metabolomic analysis in preterm infants with necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is the leading cause of death among premature infants, and there is a lack of specific early diagnostic markers. Blood sampling is expected to better reflect pathophysiological and metabolic changes in systematic illness, but there is a risk of iatrogenic anemia, especially in premature infants. Dried blood spots technique seems to have important advantages compared to whole blood sampling as it requires only 12-15 μL as sample volume. This study aimed to investigate the special metabolomics of preterm neonates at high risk of NEC using dried blood spots.

Cases and controls were strictly matched 1:1. Dried blood spots (n = 32, 16 cases-16 controls) from newborn screening were subjected to LC-MS/MS. Metabolomic data were analyzed by orthogonal partial least squares-discriminant analysis (OPLS-DA) and univariate/multivariate statistical analysis.

Compared to the control group, the NEC group had a significant reduction in seven amino acids (glycine, alanine, threonine, proline, ornithine, lysine, and asparagine).

The metabolic profile of neonates with NEC differs significantly from that of controls, making possible their separation with the use of targeted (LC-MS/MS) dried blood spots-based metabolomic analysis. Seven specific markers were identified for early detection and intervention.