Urinary prostaglandin E major urinary metabolite in neonates: Gestational age at birth-dependent dynamics and...

Prostaglandin E-major urinary metabolite (PGE-MUM) is a stable urinary marker of prostaglandin E2 metabolism and it is used for monitoring inflammation. However, its physiological dynamics in neonates across gestational ages remain unclear. Here, we aimed to investigate the longitudinal changes in PGE-MUM levels during the first 14 postnatal days (PND) in neonates with varying gestational age at birth (GA) and to examine its association with GA and neonatal inflammatory conditions.

This prospective observational study enrolled 40 neonates admitted to the neonatal intensive and growing care units at the University of Tokyo Hospital. Urinary PGE-MUM, measured by chemiluminescent enzyme immunoassay and corrected for creatinine, was tracked across PND0-14.

Data from 40 neonates (median GA: 36.3 weeks) were analyzed. Urinary PGE-MUM levels were significantly higher than adult reference values and exhibited diverse temporal patterns. Very preterm infants (<32 weeks GA) demonstrated persistently high levels or increasing trends, while term infants (≥37 weeks GA) showed gradual declines. A significant negative correlation was observed between GA and PGE-MUM at PND2 onward. Neonates with allied disorders of Hirschsprung's disease exhibited markedly elevated PGE-MUM levels at birth, followed by a sharp decline after surgical intervention. Those with non-IgE-mediated gastrointestinal food allergy displayed relatively low initial levels, gradually decreasing over time.

Urinary PGE-MUM levels were significantly elevated in neonates compared to adults, with a strong negative correlation with GA. These findings suggest their potential as a biomarker for neonatal gastrointestinal and pulmonary diseases. Further multicenter studies are warranted to validate clinical utility.