A Cohort Study of Gastric Fluid and Urine Metabolomics for the Prediction of Survival in Severe Prematurity

Abstract

Predicting survival in very preterm infants is critical in clinical medicine and parent counseling. In this prospective cohort study involving 96 very preterm infants, we evaluated whether the metabolomic analysis of gastric fluid and urine samples obtained shortly after birth could predict survival in the first 3 and 15 days of life (DOL), as well as overall survival up to hospital discharge. Gas chromatography–mass spectrometry (GC-MS) profiling was used. Uni- and multivariate statistical analyses were conducted to evaluate significant metabolites and their prognostic value. Differences in several metabolites were identified between survivors and non-survivors at the time points of the study. Binary logistic regression showed that certain metabolites in gastric fluid, including arabitol, and succinic, erythronic and threonic acids, were associated with 15 DOL and overall survival. Gastric glyceric acid was also associated with 15 DOL survival. Urine glyceric acid could predict survival in the first 3 DOL and overall survival. In conclusion, non-surviving preterm infants exhibited a different metabolic profile compared with survivors, demonstrating significant discrimination with the use of GC-MS-based gastric fluid and urine analyses. The results of this study support the usefulness of metabolomics in developing survival biomarkers in very preterm infants.

Gastric Fluid Metabolomics Predicting the Need for Surfactant Replacement Therapy in Very Preterm Infants Results of a Case–Control Study

“…Sample preparation and GC-MS analysis were applied, as previously described [12]. Briefly, the following steps were taken:…”

“…This sub-study is part of a prospective, single-center, investigation on the role of metabolomics in the prediction of neonatal outcomes in very preterm infants (born at <32 weeks' gestation), conducted from 1 March 2017 to 31 December 2020. Results describing the role of gastric fluid and urine metabolomic analysis obtained shortly after birth for the prediction of survival in very preterm infants have recently been published [12].…”

“…Herein, we analyzed data of the gastric fluid metabolomic analysis focusing on the need for surfactant replacement therapy for RDS. As previously described [12], we excluded neonates who were outborn; had known congenital infections, anomalies, or inborn errors of metabolisms; received chest compressions; and infants with missing gastric samples or those without parental consent. In the present study, infants who were administered surfactant prior to the sampling of the gastric fluid, either in the delivery room or very early after admission to the NICU, were also not included in the analysis.…”

“…Metabolomic analysis of the amniotic fluid has been used for both the prediction of preterm delivery and bronchopulmonary dysplasia [11]. Recently, gastric fluid metabolites were found to predict survival in severe prematurity [12].…”

Predicting the Need for Surfactant Replacement Therapy in Very Preterm Infants by Combining Gastric Fluid Metabolomics with Neonatal Data

“…This sub-study is part of a prospective, single center, investigation on the role of metabolomics for the prediction of neonatal outcomes in very preterm infants (born at <32 weeks' gestational) conducted from March 1 st , 2017, to December 31 st , 2020. Results describing the role of gastric fluid and urine metabolomic analysis obtained shortly after birth for the prediction of survival in very preterm infants have recently been published [12].…”