University of Padova, Department of Women's and Children's Health, Padova, Italy.
University Hospital of Padova, Neonatal Intensive Care Unit, Padova, Italy.
BMC Gastroenterol. 2024 Oct 26;24(1):380. doi: 10.1186/s12876-024-03453-y.
Necrotizing enterocolitis (NEC) is the most devastating gastrointestinal (GI) emergency in preterm neonates. Untargeted metabolomics may allow the identification of biomarkers involved in NEC pathophysiology.
We conducted a prospective study including preterm infants born at < 34 gestational weeks (GWs) whose urine was longitudinally collected at birth (< 48 h, T0) and at 14 (T1) and 28 days (T2). Neonates were followed for their development of NEC, spontaneous intestinal perforation (SIP), or other GI conditions and compared to those of matched healthy controls. Urine samples were investigated by untargeted metabolomic analysis based on mass-spectrometry.
Thirty-five patients with NEC, 5 patients with SIP, 14 patients with other GI diseases and 113 controls were enrolled and selected for metabolomic analysis on the basis of their clinical characteristics and available samples. Considering urine samples at T0, the one-class classification approach was able to correctly classify 16/20 subjects (80%) who developed NEC, 3/3 (100%) who developed SIP and 5/7 subjects (71.4%) with other GI pathologies as not belonging to the control group. Neonates with surgical NEC had higher N-acetylaspartic acid, butyrylcarnitine and propionylcarnitine levels than did those with medical NEC. Considering the time evolution of the urinary metabolome, the NEC and control groups showed differences independently of the time point.
The urinary metabolome is closely associated with the underlying GI disease from birth. Urinary metabolic features characterize NEC patients from healthy controls until 28 days of life. The early urinary metabolome has the potential to predict surgical NEC. Future studies are needed to validate our results.
坏死性小肠结肠炎（NEC）是早产儿最严重的胃肠道（GI）急症。非靶向代谢组学可能有助于确定与 NEC 病理生理学相关的生物标志物。
我们进行了一项前瞻性研究，纳入了出生胎龄（GA）<34 周的早产儿，在出生时（<48 小时，T0）和 14 天（T1）和 28 天（T2）时纵向采集尿液。对 NEC、自发性肠穿孔（SIP）或其他 GI 疾病的新生儿进行随访，并与匹配的健康对照组进行比较。通过基于质谱的非靶向代谢组学分析研究尿液样本。
共纳入 35 例 NEC 患儿、5 例 SIP 患儿、14 例其他 GI 疾病患儿和 113 例对照患儿，根据临床特征和可用样本选择进行代谢组学分析。考虑到 T0 时的尿液样本，单类分类方法能够正确分类 16/20 例（80%）发生 NEC、3/3 例（100%）发生 SIP 和 5/7 例（71.4%）其他 GI 疾病患儿不属于对照组。手术 NEC 患儿的 N-乙酰天冬氨酸、丁酰肉碱和丙酰肉碱水平高于非手术 NEC 患儿。考虑到尿液代谢组的时间演变，NEC 组和对照组的差异独立于时间点。
尿液代谢组与出生时的潜在 GI 疾病密切相关。尿液代谢特征可将 NEC 患者与健康对照组区分开来，直至 28 天。早期尿液代谢组具有预测手术 NEC 的潜力。需要进一步的研究来验证我们的结果。
