WOFAPS 2025 8th World Congress of Pediatric Surgery

Janis Karlsons ¹, Anete Rozentalberga ¹, Zanda Daneberga ², Juta Kroica ², Edvins Miklasevics ², Miki Nakazawa- Miklasevica ², Elza Elizabete Liepina ², Renars Broks ², Ingus Skadins ², Dace Gardovska ², Lasma Asare ², Zane Abola ¹

¹ Rigas Stradins University & Children's Clinical University Hospital, Department of Pediatric Surgery
² Rigas Stradins University

Background:

Necrotizing enterocolitis (NEC) is a complex and devastating gastrointestinal condition predominantly affecting preterm infants. While it is commonly identified through clinical examinations, imaging techniques, and blood tests, these conventional diagnostic approaches may not always be sufficient, particularly in the early and subtle stages of the disease. Consequently, there is a graving need for the development and validation of reliable, non-invasive biomarkers that can facilitate the early diagnosis of necrotizing enterocolitis and initiate personalised treatment and improve outcomes.

Materials and Methods:

This prospective cohort study, conducted from 2023 to 2024 at the Children's University Hospital Riga, Latvia, examined stool and urine samples collected from 7 preterm infants diagnosed with NEC. The gut microbiome was analyzed using shotgun metagenomic sequencing, while urine and fecal biomarkers were assessed using ELISA.

Results:

This study evaluated 7 NEC preterm infants, five female, three male infants, mean (SD) gestational age (GA) (weeks) 27 (24-30), mean (SD) birth wight (BW)(grams) 964 (673-1233). Common presenting symptoms across all cases in NEC included feeding intolerance, abdominal distension, and bile-stained vomiting. Four of the infants were fed donor breastmilk, one received formula and two breastmilk. Urinary biomarkers Prostaglandin E2 (PGE2) and Lactate Dehydrogenase (LDH) were significantly elevated in NEC patients during the early days of diagnosis (p<0.05), while no significant differences were observed for I-FABP and Serum Amyloid A (SAA). Fecal biomarkers LDH and Glycogen Debranching Enzyme (GDE) were undetectable. The fecal microbiome composition analysis revealed significant dysbiosis, with Firmicutes dominating in four patients, Actinobacteria in one patient, Proteobacteria in one patient, and Ascomycota in one patient. Pathogenic species such as Enterococcus faecalis, Staphylococcus haemolyticus, and Klebsiella were predominant. There is a slight decrease in alpha diversity metrics after the NEC diagnosis, including reductions in species richness (Chao1 index 21.00 vs 17.00) and diversity (Shannon 3.56 vs 3.43 and Simpson indices 0.90 vs 0.89)

Conclusions:

NEC appears linked to gut microbiome dysbiosis, with an abundance of pathogenic species and reduced diversity. Feeding type influenced the microbiome, suggesting the importance of further research into microbiome-targeted interventions. This study identified potential PGE2 and LDH biomarkers for early NEC diagnosis and management, warranting validation in larger studies.