Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

The futile search for biomarkers for necrotizing enterocolitis

Pediatric Research (2026)Cite this article

The article by Hameedi et al.1 is intended to address whether blood intestinal fatty acid binding protein (IFABP) levels can be utilized as a biomarker for intestinal stress before the clinical suspicion of necrotizing enterocolitis (NEC). The study was a prospective evaluation of neonates less than or equal to 32 weeks of gestation enrolled within 72 h after birth. IFABP concentrations were evaluated using ELISA assays in 96 patients. Nine were diagnosed with NEC. IFABP levels remained low with early feeding advancement, but once feedings exceeded 60 ml per kilogram per day, IFABP levels began to diverge, with those who subsequently developed NEC exhibiting elevations compared to controls. The authors suggest IFABP may be useful as a biomarker for emerging NEC.

This study is one of many that attempt to evaluate early biomarkers as indicators for the development of NEC. C-reactive protein, IFABP, Claudin-3, calprotectin, and numerous other markers have been evaluated but have for good reason, resulted in minimal, if any, clinical adoption.2,3,4,5

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Hameedi S. G., Wright J. G., Schafer C. G., Sbragia L. & Olutoye O. O. Serum intestinal fatty acid binding protein is elevated during feeding advancement in necrotizing enterocolitis. Pediatr. Res. https://doi.org/10.1038/s41390-025-04614-9 (2025).

  2. Pimenta, S., Pissarra, S., Soares, P., Azevedo, I. & Pereira-Nunes, J. Serum biomarkers in the early detection of necrotizing enterocolitis: a systematic review. J. Perinat. Med. 53, 966–992 (2025).

    Article  CAS  PubMed  Google Scholar 

  3. Garg, P. M. et al. Tight junction proteins and intestinal health in preterm infants. J. Neonatal Perinat. Med. 18, 409–418 (2025).

    Article  Google Scholar 

  4. Sbragia, L. et al. Intestinal fatty acid-binding protein as a marker of necrotizing enterocolitis incidence and severity: a scoping review. J. Surg. Res. 303, 613–627 (2024).

    Article  CAS  PubMed  Google Scholar 

  5. Sokou, R. et al. Diagnostic and prognostic value of hematological parameters in necrotizing enterocolitis: a systematic review. J. Clin. Med. 14, 2530 (2025).

  6. Coufal, S. et al. Intestinal fatty acid-binding protein can distinguish necrotizing enterocolitis from sepsis in the early stage of the disease. J. Immunol. Res. 2016, 5727312 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Abdel-Haie, O. M., Behiry, E. G., Abd Almonaem, E. R., Ahmad, E. S. & Assar, E. H. Predictive and diagnostic value of serum intestinal fatty acid binding protein in neonatal necrotizing enterocolitis (case series). Ann. Med. Surg. 21, 9–13 (2017).

    Article  Google Scholar 

  8. Patel, R. M., Ferguson, J., McElroy, S. J., Khashu, M. & Caplan, M. S. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr. Res. 88, 10–15 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Neu, J. Necrotizing enterocolitis: the future. Neonatology 117, 240–244 (2020).

    Article  PubMed  Google Scholar 

  10. Bell, M. J. et al. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann. Surg. 187, 1–6 (1978).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Gipson,D. R. et al. Reassessing acquired neonatal intestinal diseases using unsupervised machine learning. Pediatr. Res. https://doi.org/10.1038/s41390-024-03074-x (2024).

  12. Cuna A., Premkumar M. H. & Sampath V. Artificial intelligence to classify acquired intestinal injury in preterm neonates-a new perspective. Pediatr. Res. 18, https://doi.org/10.1038/s41390-024-03148-w (2024).

  13. Martin, C. R. Definitions of necrotizing enterocolitis: What are we defining and is machine learning the answer? Pediatr Res. 91, 488–489 (2022).

    Article  PubMed  Google Scholar 

Download references

Funding

The corresponding author is on the Scientific Advisory Committee for Medela, is the Principal Investigator for a Clinical Trial by Infant Bacterial Therapeutics has been on the speaker’s bureau for Mead Johnson and has served as an expert witness for Abbott and Winston Strawn, LLP. There is no funding support for this invited commentary.

Author information

Authors and Affiliations

  1. University of Florida, Gainesville, FL, USA

    Josef Neu

Authors
  1. Josef Neu
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Josef Neu.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Neu, J. The futile search for biomarkers for necrotizing enterocolitis. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-04801-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41390-026-04801-2

Search

Advanced search

Quick links