Neonatal Food Protein-Induced Enterocolitis: Current Insights and Knowledge Gaps

Area of Science:

• Pediatric Gastroenterology
• Neonatology
• Immunology

Background:

• Food Protein-Induced Enterocolitis Syndrome (FPIES) is well-defined in children, but neonatal FPIES (N-FPIES) remains poorly understood.
• N-FPIES exhibits distinct pathophysiology, including a prevalent TH2 response, and specific clinical features complicating diagnosis.
• Genetic, environmental, and microbiota factors are implicated in N-FPIES development, potentially affecting gut barrier function and immune regulation.

Purpose of the Study:

• To review the current understanding of neonatal FPIES (N-FPIES).
• To highlight challenges in N-FPIES pathophysiology, clinical presentation, and diagnosis.
• To discuss current and needed treatment strategies for N-FPIES.

Main Methods:

• Literature review focusing on pathophysiology, clinical presentation, diagnosis, and treatment of N-FPIES.
• Analysis of recent evidence regarding microbiota signatures, immune responses, and genetic/environmental risk factors.
• Comparison of N-FPIES clinical features with established FPIES criteria and other neonatal conditions like NEC.

Main Results:

• N-FPIES pathophysiology involves a TH2 response, gut barrier dysfunction, altered T-regulatory cells, and abnormal serotonin production.
• Clinical presentation in neonates may not meet current FPIES diagnostic criteria, mimicking other neonatal conditions, especially necrotizing enterocolitis (NEC).
• Current diagnostic criteria may be insufficient for N-FPIES, necessitating differentiation from surgical neonatal emergencies.

Conclusions:

• Refining diagnostic criteria for N-FPIES is a clinical priority to aid physicians.
• Improved understanding of N-FPIES pathophysiology and clinical presentation is essential.
• Larger clinical trials are required to optimize treatment strategies for N-FPIES in term and preterm newborns.