Predicting intestinal recovery after necrotizing enterocolitis in preterm infants

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 (r int SO 2 ) and collected urinary intestinal-fatty acid binding protein (I-FABP u ) 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 r int SO 2 , its range, and I-FABP u 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 r int SO 2 ≥ 53% combined with mean r int SO 2range ≥ 50% predicted FEFt < 14 days with OR 16.7 (CI: 2.3-122.2). The r int SO 2range was smaller (33% vs. 51%, p < 0.01) and I-FABP u 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 r int SO 2 , its range, and I-FABP u after the first re-feed after NEC predicted intestinal recovery. These biomarkers have potential value in individualizing feeding regimens after NEC.

Plasma citrulline during the first 48 h after onset of necrotizing enterocolitis in preterm infants

“…This suggests that intestinal recovery, including recovery of enterocyte function, is different after surgical intervention than during conservative treatment, possibly due to the removal of affected tissue. Similarly, in the NaNECtrial we previously found that intestinal oxygen saturation measurements after the first enteral re-feed after NEC was associated with FEFt, particularly in the conservatively treated group, while not in the surgically treated group [18] .…”

“…First, the NoNEC trial (NTR3239) was performed between 2010 and 2012 [17] . Second, the NaNEC trial (NTR4816) was performed between 2015 and 2017 [18] . In both trials, the onset of NEC was defined as the time of the first abdominal X-ray made upon clinical suspicion of NEC including X-rays performed in referring hospitals.…”

Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis

“…Some of the foci of management strategies at our center include careful postoperative fluid and nutritional management, early and aggressive enteral feeding advancement, and use of PN to achieve goal macronutrient provision [25]. There is emerging literature on biomarkers to predict intestinal recovery [26]. Novel treatments such as teduglutide, a recombinant human glucagon-like peptide-2 analog that promotes an intestinal adaptive response, may be the next strategy to achieve enteral autonomy in these patients [27].…”

Nutrition in Necrotizing Enterocolitis and Following Intestinal Resection

“…In a 2019 prospective observational cohort study, Kuik, et al measured the regional intestinal oxygen saturation (r int SO 2 ) by near-infrared spectroscopy (NIRS) and intestinal fatty acid binding protein (I-FABP u ) in the urine of 27 preterm infants. The study found that when measured after the first re-feed, these markers were predictive of post-NEC stricture, though not of recurrent NEC [36]. Additionally, a recent study on infants between 24-40 weeks postmenstrual age found high intestinal alkaline phosphatase (IAP) in stool and low IAP enzyme activity in patients with NEC compared to those without disease; IAP also was a useful biomarker for disease severity [37].…”