Pediatrics · 2 h ago
Stool Biomarkers Discriminate Confirmed NEC in Preterm Infants
An ancillary analysis of the multicenter ClosNEC cohort assessed six stool biomarkers in 130 infants born before 32 weeks’ gestation. Secretory IgA had the strongest individual discrimination for confirmed necrotizing enterocolitis (NEC), while a six-marker model achieved an AUC of 0.86.
- Analysis included 42 infants with confirmed NEC and 88 without NEC.
- Secretory IgA had the strongest individual discrimination (AUC 0.82).
- Six-marker complete-case model achieved an AUC of 0.86.
- Prospective validation in suspected NEC cases is needed.
Researchers conducted an ancillary biomarker analysis within the ClosNEC cohort, enrolling preterm infants born before 32 weeks’ gestation across 20 French neonatal intensive care units. Stool samples from 42 infants with confirmed NEC (modified Bell stage II or higher) were compared with samples from 88 infants without NEC, collected at similar postnatal ages. Six fecal biomarkers were measured using ELISA, and discrimination was assessed with receiver operating characteristic analysis and logistic regression.
Concentrations differed between groups for all biomarkers except cingulin. Secretory immunoglobulin A had the highest individual discrimination (AUC 0.82), followed by fecal calprotectin (0.74) and α1-antitrypsin (0.73). A four-biomarker model had an AUC of 0.83; a six-biomarker complete-case model, based on 108 infants, had an AUC of 0.86.
The results identify candidate noninvasive markers for further study, but do not establish their performance in the clinical setting where NEC is suspected. The comparison was with infants without NEC, and the authors call for prospective validation that includes relevant competing neonatal diagnoses. The exploratory analysis did not adjust p values for multiple comparisons.
In practice
For preterm infants, stool secretory IgA and other measured biomarkers showed discrimination between confirmed NEC and infants without NEC in an exploratory cohort. These findings do not support changing diagnostic practice: the comparison did not test performance among infants evaluated for suspected NEC with competing neonatal diagnoses, and prospective validation is needed. The AUC results describe discrimination, not evidence that biomarker testing improves clinical outcomes or can replace current assessment.
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Pediatric Research: Stool biomarkers discriminate confirmed necrotizing enterocolitis in preterm infants ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.