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. 2025 Apr 28;184(5):316.
doi: 10.1007/s00431-025-06146-0.

The predictive value of maternal and neonatal inflammatory biomarkers for necrotizing enterocolitis

Melinda Matyas  1 , Tamás Ilyés  2 , Madalina Valeanu  3 , Alexandra M Crăciun  2 , Monica Hășmășanu  4 , Nicoleta Grosu  4 , Gabriela Zaharie  4
Affiliations

The predictive value of maternal and neonatal inflammatory biomarkers for necrotizing enterocolitis

Melinda Matyas et al. Eur J Pediatr. .

Abstract

More than half of preterm births are triggered by inflammatory processes at the foeto-maternal interface. These inflammatory processes can persist after birth due to the unique vulnerabilities of preterm infants, often resulting in sustained inflammation with a role in complications such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and periventricular leukomalacia (PVL). The aim of this study was to evaluate the predictive value of maternal inflammatory status, assessed through biomarkers of inflammation (CRP, chorioamnionitis, preeclampsia), and neonatal inflammatory markers (CRP 1, CRP 2, PCT, IL3, MMP9) on the incidence of NEC in preterm neonates. We conducted a prospective longitudinal study in the 1st Neonatology Department, Cluj-Napoca, Romania. A total of 82 preterm newborns (gestational age < 34 weeks + 6 days) were enrolled in the study. Interleukin-3 (IL3) and matrix metalloproteinase-9 (MMP9) levels were measured using the ELISA technique. Additionally, C-reactive protein (CRP) and procalcitonin (PCT) were measured in the first days of life. The correlation between these inflammatory markers and the incidence of NEC was analyzed. Furthermore, we examined the role of maternal inflammation and chorioamnionitis in relation to NEC incidence. Out of the 82 neonates enrolled, 20 developed NEC. Neonates who developed NEC had higher IL3 levels at birth. A significant positive correlation was found between maternal CRP levels and neonatal IL3 levels (r = 0.541, p < 0.001). In the NEC group, maternal CRP levels were also elevated compared to those in neonates who did not develop NEC.

Conclusion: Neonatal inflammation is associated with an increased incidence of NEC. Prenatal inflammatory conditions appear to trigger a persistent inflammatory process in preterm neonates, raising the risk of NEC.

What is known: • NEC is a multifactorial disease of preterm newborn with multiple maternal and neonatal risk factors.

What is new: • Evaluate the probability of NEC at preterm neonates of mothers with ongoing inflammatory conditions during pregnancy.

Keywords: Biomarker; Inflammation; Necrotizing enterocolitis; Preterm birth.

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Conflict of interest statement

Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of Medicine and Pharmacy Cluj Napoca, Romania (Date 25.05.2022/No.127). Consent to participate: Written informed consent was obtained from the parents. Competing Interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A ROC curve IL3; sensitivity 0.67; specificity 0.74. B ROC curve MMP9; sensitivity 0.22; specificity 0.83. C ROC curve maternal CRP; sensitivity 0.59; specificity 0.78
See this image and copyright information in PMC

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