Stool biomarkers discriminate confirmed necrotizing enterocolitis in preterm infants
In brief
Six stool biomarkers distinguish confirmed necrotizing enterocolitis, with AUC 0.86
In 130 preterm infants, a six-biomarker stool panel distinguished confirmed necrotizing enterocolitis from no NEC, with an area under the curve of 0.86 in 108 infants with complete data. Secretory immunoglobulin A performed best alone, with an AUC of 0.82; validation in infants being evaluated for suspected NEC and other neonatal conditions is still needed.
- Journal
- Pediatric research (Q1)
- Published
- 23 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Maria Abou Diwan, Johanne Delannoy, Laurent Ferraris, Jean-Christophe Rozé, Nathalie Kapel, Marie-José Butel, et al.
- PMID
- 42919831
- DOI
- 10.1038/s41390-026-05566-4
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 25 October 2026): Human stool biomarker measurement and diagnostic discrimination
Abstract
BACKGROUND: Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in preterm infants. Early diagnosis remains challenging because clinical signs are nonspecific. We evaluated whether stool biomarkers could discriminate preterm infants with NEC from those without NEC. METHODS: We performed an ancillary analysis within the multicenter ClosNEC cohort of infants born before 32 weeks' gestation. Stool samples were collected at diagnosis in infants with confirmed NEC (Bell stage II or higher) and at comparable postnatal ages in preterm infants without NEC. Fecal calprotectin (fCal), human β-defensin-2, α1-antitrypsin (α1-AT), secretory immunoglobulin A (sIgA), cingulin (CGN), and eosinophil-derived neurotoxin were quantified using enzyme‑linked immunosorbent assay (ELISA) kits. Discriminatory performance was assessed using receiver operating characteristic analysis and logistic regression. RESULTS: The analysis included 130 preterm infants: 42 with confirmed NEC and 88 without NEC. Biomarker concentrations differed between groups for all markers except CGN. sIgA showed the best individual discrimination (AUC = 0.82), followed by fCal (AUC = 0.74) and α1-AT (AUC = 0.73). The four-biomarker model yielded an AUC = 0.83, whereas the six-biomarker complete-case model yielded an AUC = 0.86. CONCLUSION: Stool biomarkers discriminated infants with NEC from those without NEC. Our findings support prospective validation in infants evaluated for suspected NEC, including clinically relevant comparator groups. IMPACT: Stool biomarkers distinguished infants with confirmed NEC from infants without NEC in a multicenter cohort. Secretory IgA showed the strongest individual discrimination, with an AUC of 0.82. A six-biomarker complete-case model yielded an AUC of 0.86 in 108 infants. These biomarkers are potential candidates for further evaluation as noninvasive tools for NEC assessment. Validation is needed in infants with suspected NEC and competing neonatal diagnoses.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.