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_intSO₂) 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_intSO₂, 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_intSO₂ ≥ 53% combined with mean r_intSO_2range ≥ 50% predicted FEFt < 14 days with OR 16.7 (CI: 2.3–122.2). The r_intSO_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_intSO₂, 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.