Predicting intestinal recovery after necrotizing enterocolitis in preterm infants

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.