Prostaglandin E-major urinary metabolite as a noninvasive surrogate marker for infantile necrotizing enterocolitis

Abstract

Background: Early definitive diagnosis of necrotizing enterocolitis (NEC) based on Bell's staging criteria is difficult because there are few observable changes on abdominal imaging and blood chemistry tests at the onset of the disease.

Purpose: To investigate whether prostaglandin E-2 major urinary metabolite (PGE-MUM) can be a useful surrogate marker reflecting the disease state and severity of NEC in infants.

Methods: Infants were enrolled in this study between January 2014 and December 2016. NEC diagnosis was based on Bell's staging criteria > Stage II or necrotic bowel observed at surgery. After diagnosis, PGE-MUM level was measured and compared with that of the other disease and healthy infant groups.

Results: Median PGE-MUM value was highest in the NEC group (576 [65-3672] μg/g•Cre/BSA × 1000), followed by the other disease group (94 [57-296] μg/g•Cre/BSA × 1000) and the healthy infant group (19 [10-44] μg/g•Cre/BSA × 1000) (sensitivity: 92.3%, specificity: 81.5%, accuracy: 85.0%; p < 0.01). PGE-MUM level correlated with improved status of NEC, length of necrotic intestine, and Bell's staging criteria.

Conclusions: PGE-MUM level may be a useful surrogate biomarker reflecting the disease state of NEC. The method of urine sample collection is also advantageous, being noninvasive for infants. This is the first study reporting PGE-MUM level in NEC.

Type of study: Study of diagnostic test.

Level of evidence: LEVEL II.

Keywords: Necrotizing enterocolitis; Noninvasive; PGE-major urinary metabolite; Prostaglandin E.