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  • Clinical Research Article
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Impact of fetal inflammatory response on the severity of necrotizing enterocolitis in preterm infants

Pediatric Research volume 95, pages 1308–1315 (2024)Cite this article

Abstract

Objective

Neonates born with fetal inflammatory response (FIR) are at increased risk for adverse neonatal outcomes. Our objective was to determine whether FIR and its severity is associated with severity of necrotizing enterocolitis (NEC) in preterm infants.

Methods

A case-control retrospective study of infants <33 weeks gestational age or <1500 g birthweight, including 260 with stage I–III NEC and 520 controls matched for gestational age. Placental pathology was evaluated, and FIR progression and its severity were defined according to Amsterdam classification.

Results

In this study, mild FIR (i.e., stage 1 FIR) was present in 52 controls (10.0%) and 22 infants with stage I–III NEC (8.5%), while moderate to severe FIR (i.e., ≥stage 2 FIR) was present in 16 controls (3.1%) and 47 infants with stage I–III NEC (18.1%). Both stage and grade of FIR were associated with stage of NEC (P < 0.001). On multinomial logistic regression, stage III NEC was associated with stage of FIR (P < 0.001).

Conclusion

This is the first report demonstrating the association between progression and increasing severity of FIR and stage of NEC.

Impact

  • Fetal Inflammatory Response (FIR) and its progression and severity are associated with the stages of necrotizing enterocolitis (NEC).

  • This is the first study demonstrating the impact of progression and severity of FIR on stage III NEC.

  • These observations provide additional insight into understanding the impact of intrauterine exposure to inflammation on the severity of NEC in preterm infants.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We wish to thank several people who participated in data collection: Patti J Burchfield, RN, Pollieanna M Sepulveda, RN and Anita Thomas, RN.

Funding

This work was supported by Children’s Clinical Research Advisory Council (CCRAC) grant awarded to I.N.M.

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Imran Nazir Mir, Mariela Sánchez-Rosado, Jordan Reis, Myra Wyckoff, Sujir Pritha Nayak & Luc Brion

  2. Division of Neonatology, Joe DiMaggio Children’s Hospital, Hollywood, FL, USA

    Mariela Sánchez-Rosado

  3. Baylor Scott & White, Dallas, TX, USA

    Jordan Reis

  4. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Naseem Uddin

  5. Parkland Health and Hospital System, Dallas, TX, USA

    L. Steven Brown

  6. Department of Radiology, University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA

    Kate Louise Mangona

  7. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, TX, USA

    David Nelson

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Contributions

I.N.M. wrote the first version of the manuscript. L.P.B. and S.B. performed statistical analyses. All authors participated in the study design, data collection, data interpretation, and revision and approval of the final version of the manuscript.

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Correspondence to Imran Nazir Mir.

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Mir, I.N., Sánchez-Rosado, M., Reis, J. et al. Impact of fetal inflammatory response on the severity of necrotizing enterocolitis in preterm infants. Pediatr Res 95, 1308–1315 (2024). https://doi.org/10.1038/s41390-023-02942-2

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  • DOI: https://doi.org/10.1038/s41390-023-02942-2

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