Biomarkers of necrotizing enterocolitis: a review of literature

Abstract

Necrotizing enterocolitis (NEC) is among the most serious gastrointestinal emergency in very low birth weight (VLBW), extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGAN), affecting 7-14% of these neonates. Despite extensive research, the underlying aetiology of NEC still remains blurred. Due to high mortality, morbidity and its delayed presentation, early detection of NEC is considered to be lifesaving. A number of biomarkers have been studied for early detection and prediction of severity of NEC but till date, no ideal marker has been discovered. Molecular techniques like proteomic and metabolomic have recently emerged in the field for the development of biomarkers for early detection and understanding the pathophysiology of NEC. We did literature search for identifying all biomarkers that have been used for the detection of NEC and, in this review article, we discuss these biomarkers along with the available current evidence.

Autoinducer-2 May Be a New Biomarker for Monitoring Neonatal Necrotizing Enterocolitis

“…Recently, there have been many publications examining NEC biomarkers in the past decades, such as cytokines (IL-8, TGF-β, IL-1RA, IL-1β), calprotectin, the non-protein amino acid citrulline, urine intestinal fatty acid-binding protein (IFABP), serum amyloid A (SAA), fecal calprotectin, the EpCAM/MMp7 ratio, a serum protein panel, volatile organic compounds, acylcarnitines, fibrinogen-g dimers, and so on (Rusconi et al, 2017;Hackam et al, 2018). However, no biomarkers have achieved widespread clinical application, and existing biomarkers cannot reflect intestinal flora disorder (Anatoly et al, 2013;Neu, 2014;Garg et al, 2018); furthermore, such examinations are usually invasive or radioactive (Stoll et al, 2015;Rusconi et al, 2017).…”

Berberine reduces the occurrence of neonatal necrotizing enterocolitis by reducing the inflammatory response

“…In the present study, NEC symptoms were evident 2 days after the model was established. There are differences in the clinical manifestation of NEC; mild symptoms, including a swollen abdomen and diarrhea, can rapidly develop into necrosis of the intestinal wall, perforation or peritonitis (2,8). Therefore, prevention is particularly important.…”

“…The severity of NEC varies from case to case any may affect the entire intestine (6,7). Studies have demonstrated that various factors are associated with an increased risk of developing NEC; its pathogenesis has been explored using animal models in an attempt to develop more effective therapeutic strategies (8,9). The latest studies have indicated that inflammatory cascades serve an important role in the pathogenesis of neonatal NEC (10,11).…”

Staging of necrotising enterocolitis by Bell's criteria is supported by a statistical pattern analysis of clinical and radiological variables

“…The decision between surgical treatment and conservative treatment can, therefore, be difficult. Biomarkers have been one of the important topics of NEC research in the last few years , but these studies have not yet given clinicians any new biomarkers that are reliable enough to be included in the everyday clinic . Hopefully, the future will provide more knowledge in this area.…”