Stool biomarkers may be effective in the evaluation of necrotizing enterocolitis in preterm infants

1. Stool biomarkers distinguished preterm infants with confirmed necrotizing enterocolitis (NEC) from preterm infants without NEC, with secretory immunoglobulin A showing the best individual discrimination.

Evidence Rating Level: 2 (Good)

Stool-based biomarkers have emerged as promising tools for improving the discrimination of necrotizing enterocolitis (NEC). However, previous studies have mainly focused on single biomarkers conducted at single centers. This study thus examined whether six stool biomarkers discriminated preterm infants with NEC from those without NEC from a multicenter cohort. This ancillary analysis included infants born before 32 weeks’ gestation in France. Stool samples from preterm infants with NEC (Bell stage II or higher) were collected at diagnosis, while samples from those without NEC were collected at comparable postnatal ages. The six stool biomarkers included fecal calprotectin (fCal), human β-defensin-2, α1-antitrypsin (α1-AT), secretory immunoglobulin A (sIgA), cingulin (CGN), and eosinophil-derived neurotoxin. In total, 130 preterm infants were included, of whom 42 had NEC and 88 did not. In both groups, the median gestational age was 28 weeks (p > 0.9). The stool biomarker showing strongest individual discrimination was sIgA (area under the curve [AUC] = 0.82), followed by fCal (AUC = 0.74) and α1-AT (AUC = 0.73). The four-biomarker model (α1-AT, EDN, hBD-2, and sIgA) yielded an AUC = 0.83, whereas the six-biomarker complete-case model yielded an AUC = 0.86. Overall, this study found that stool biomarkers distinguished infants with confirmed NEC from preterm infants without NEC, with sIgA showing the best individual discrimination, and multimarker models performing modestly better. These findings highlight the potential of these biomarkers as noninvasive tools for NEC assessment.

Click here to read this study in Pediatric Research

Citation: Diwan MA, Delannoy J, Ferraris L, Rozé JC, Kapel N, Butel MJ, et al. Stool biomarkers discriminate confirmed necrotizing enterocolitis in preterm infants. Pediatr Res. 2026 Oct 23. doi: 10.1038/s41390-026-05566-4. Epub ahead of print. PMID: 42919831.

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