509 - Necrotising Enterocolitis: A Systematic Review of Potential Biomarkers

Poster Number: 509
Publication Number: 509.426

Alannah E. McMahon, Trinity College Dublin, Co.Clare, Clare, Ireland; Iffat Khalid, Trinity College Dublin Ireland, PORTLAOISE, Laois, Ireland; Magdalina Mazheda Fadel, Trinity College Dublin, Carlow, Carlow, Ireland; Philip Gavigan, Trinity College Dublin, Dublin, Dublin, Ireland; Eman Isweisi, Trinity college Dublin, Saggart, Dublin, Ireland; Gergana Semova, Trinity College Dublin, the University of Dublin,Dublin, Dublin, Dublin, Ireland; Judith Meehan, Trinity College Dublin, Dublin, Dublin, Ireland; Edna f. Roche, University of Dublin Trinity College and CHI Tallaght, Dublin, Dublin, Ireland; Muhammad Ashhad Faizan, Trinity College Dublin, Mississauga, ON, Canada; Asten Yeo, Trinity College Dublin, the University of Dublin, Singapore, N/A, Singapore; Aoife Branagan, Coombe Woman and Infants University Hospital, Dublin, Dublin, Ireland; Eleanor J Molloy, Trinity college the university of dublin, Dublin, Dublin, Ireland; Saffron ONeill, Trinity College Dublin, Dublin, Dublin, Ireland

Background: Necrotising enterocolitis (NEC) is an acute inflammatory condition of the gut, affecting preterm neonates mostly. Currently, Bell's Modified criteria is used to diagnose this condition. However, owing to over-reliance on non-specific and overlapping signs and symptoms with other conditions, there is a crucial need to augment this standard for improving the management of NEC. Morevoer, the lack of established biomarkers specific for NEC, and using non-specific biomarkers makes it challenging to diagnose NEC which rapidly progresses into the fulminant phase.  

Objective: The objective of this systematic review was to assess the diagnostic utility of potential biomarkers associated with necrotizing enterocolitis (NEC)

Design/Methods: We conducted an electronic search of the available literature using the PubMed, Embase, and Cochrane electronic databases using the search terms (“necrotizing enterocolitis” OR “necrotising enterocolitis” OR “NEC”) AND (‘biomarker*’ OR ‘biological marker’). Studies reporting data on the diagnostic accuracy of biomarkers for NEC were included. Results were restricted to full-text articles of studies in the English language, available until September 2021. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.

Results: 231 studies were screened, after which we were left with a yield of 27 studies for analysis. Most studies investigated the ability of a biomarker to differentiate Bell’s stage ≥II NEC from controls and Bell’s stage II from stage III. For identifying Bell's stage ≥II, we found high sensitivity and specificity for faecal calprotectin (97.14%, 100%), serum calprotectin (100%, 96.4%), a panel consisting of urine proteins CST3, PEDF, and RET4 (96%, 90%), and maternal human milk oligosaccharide DSNLT (90%, 90%) when sampled prior to or around the initial diagnosis of NEC, while IL-33 demonstrated high accuracy (100%, 94.4%) when sampled ≥3 days post-initial diagnosis. For differentiating between Bell’s stage II and stage III, only urinary intestinal fatty acid binding protein (I-FABPu) demonstrated high sensitivity and specificity (90%, 92%) when sampled around the time of initial diagnosis.Conclusion(s): Calprotectin, urinary CST3, PEDF, and RET4, and maternal DSNLT demonstrate usefulness in the initial diagnosis of NEC, while IL-33 may be used for diagnostic confirmation in the follow-up and I-FABPu in the early differentiation of Bell's stage II NEC from stage III. However, data supporting their clinical use is insufficient, and limitations associated with sample modality and collection may hinder their clinical use.
CV Muhammad Ashhad FaizanResume 2021 Faizan.pdf
QUADAS Risk Assessment analysis