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The predictive value of maternal and neonatal inflammatory biomarkers for necrotizing enterocolitis
Melinda Matyas1, Tamás Ilyés2, Madalina Valeanu3
1Neonatology Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. melimatyas@yahoo.com.
Insights
Maternal inflammation and elevated neonatal Interleukin-3 (IL3) levels predict necrotizing enterocolitis (NEC) in preterm infants. Prenatal inflammation can persist, increasing NEC risk in vulnerable newborns.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Immunology
Background:
- Over half of preterm births stem from inflammation at the fetomaternal interface.
- Inflammation can persist post-birth in preterm infants, contributing to complications like necrotizing enterocolitis (NEC).
- NEC is a multifactorial disease in preterm newborns with numerous maternal and neonatal risk factors.
Purpose of the Study:
- To assess the predictive value of maternal inflammatory markers (C-reactive protein [CRP], chorioamnionitis, preeclampsia) and neonatal inflammatory markers (CRP, procalcitonin [PCT], IL3, MMP9) for NEC incidence.
- To evaluate the probability of NEC in preterm neonates born to mothers with ongoing inflammatory conditions during pregnancy.
Main Methods:
- Prospective longitudinal study of 82 preterm neonates (gestational age < 34 weeks + 6 days).
- Measurement of maternal CRP, neonatal CRP, PCT, IL3, and MMP9 levels.
- Analysis of correlations between maternal and neonatal inflammatory markers and NEC incidence.
Main Results:
- Twenty of 82 neonates developed NEC.
- Neonates who developed NEC exhibited higher IL3 levels at birth.
- A significant positive correlation was observed between maternal CRP levels and neonatal IL3 levels (r=0.541, p<0.001).
- Maternal CRP levels were elevated in the NEC group compared to the non-NEC group.
Conclusions:
- Neonatal inflammation is linked to a higher incidence of NEC.
- Prenatal inflammatory conditions may initiate persistent inflammation in preterm neonates, elevating NEC risk.
Abstract:
More than half of preterm births are triggered by inflammatory processes at the foeto-maternal interface. These inflammatory processes can persist after birth due to the unique vulnerabilities of preterm infants, often resulting in sustained inflammation with a role in complications such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and periventricular leukomalacia (PVL). The aim of this study was to evaluate the predictive value of maternal inflammatory status, assessed through biomarkers of inflammation (CRP, chorioamnionitis, preeclampsia), and neonatal inflammatory markers (CRP 1, CRP 2, PCT, IL3, MMP9) on the incidence of NEC in preterm neonates. We conducted a prospective longitudinal study in the 1st Neonatology Department, Cluj-Napoca, Romania. A total of 82 preterm newborns (gestational age < 34 weeks + 6 days) were enrolled in the study. Interleukin-3 (IL3) and matrix metalloproteinase-9 (MMP9) levels were measured using the ELISA technique. Additionally, C-reactive protein (CRP) and procalcitonin (PCT) were measured in the first days of life. The correlation between these inflammatory markers and the incidence of NEC was analyzed. Furthermore, we examined the role of maternal inflammation and chorioamnionitis in relation to NEC incidence. Out of the 82 neonates enrolled, 20 developed NEC. Neonates who developed NEC had higher IL3 levels at birth. A significant positive correlation was found between maternal CRP levels and neonatal IL3 levels (r = 0.541, p < 0.001). In the NEC group, maternal CRP levels were also elevated compared to those in neonates who did not develop NEC.
Conclusion:
Neonatal inflammation is associated with an increased incidence of NEC. Prenatal inflammatory conditions appear to trigger a persistent inflammatory process in preterm neonates, raising the risk of NEC.
What Is Known:
• NEC is a multifactorial disease of preterm newborn with multiple maternal and neonatal risk factors.
What Is New:
• Evaluate the probability of NEC at preterm neonates of mothers with ongoing inflammatory conditions during pregnancy.
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