Abstract
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.
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Acknowledgements
We would like to acknowledge the nurses, medical staff of the NICU of Beatrix Children’s Hospital in Groningen, and the medical students, for helping with data collection and for creating the opportunity to carry out this study. This study was part of the research program of the postgraduate school for Behavioural and Cognitive Neurosciences, University of Groningen. S.J.K., W.S.K., and M.J.M. were financially supported by a grant from the Junior Scientific Master Class of the University of Groningen, Groningen, the Netherlands.
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S.J.K., E.M.W.K., J.B.F.H., and A.F.B. conceptualized and designed the study. S.J.K., W.S.K., and M.J.M. collected the data. S.J.K. analyzed the data and drafted the initial manuscript. E.M.W.K. supervised the study. W.S.K., M.J.M., A.F.B., J.B.F.H., and E.M.W.K. reviewed and revised the manuscript critically. All authors approved the final manuscript as submitted.
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Kuik, S.J., Kalteren, W.S., Mebius, M.J. et al. Predicting intestinal recovery after necrotizing enterocolitis in preterm infants. Pediatr Res 87, 903–909 (2020). https://doi.org/10.1038/s41390-019-0634-y
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DOI: https://doi.org/10.1038/s41390-019-0634-y
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