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Fetal inflammatory response spectrum: mapping its impact on severity of necrotising enterocolitis

Pediatric Research volume 95, pages 1179–1180 (2024)Cite this article

Necrotizing enterocolitis (NEC) is a severe gastrointestinal disorder characterized by inflammation and tissue death in the intestine, predominantly affecting premature infants.1 It poses a significant threat to neonatal health, often leading to substantial morbidity and mortality.2 While the exact cause of NEC remains elusive, prematurity emerges as a prominent risk factor.3 Additionally, studies have identified inflammation of antenatal origin as a crucial risk factor for NEC.4,5 These studies have used chorioamnionitis as a proxy of antenatal inflammation in linking the association with NEC.4 Nevertheless, there are nuanced distinctions that one must carefully consider when understanding the influence of antenatal inflammation on NEC.

Chorioamnionitis, characterized by inflammation of the chorion and amnion, is widely recognized as a maternal inflammatory response during pregnancy. Distinct from this, inflammation of umbilical and chorionic vessels is identified as a fetal inflammatory response. While chorioamnionitis itself poses a significant risk factor for NEC, the presence of a fetal inflammatory response intensifies this risk considerably.4,6 However, the extent to which the severity of fetal inflammatory response influences the severity of necrotizing enterocolitis remains uncertain. In this issue of Pediatric Research, a study by Mir et al. specifically focuses on exploring the association between the intensity of fetal inflammatory response and the severity of NEC in preterm infants at a tertiary-level intensive care unit in Dallas, TX, thereby contributing valuable insights to this complex medical landscape.7

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Fig. 1: Infographic illustrating the association between chorioamnionitis and necrotizing enterocolitis (light blue arrow) with an amplified risk in the presence of fetal inflammatory response (dark blue arrows).

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Acknowledgements

No specific funding for this commentary. Abdul Razak receives scholarships from Monash University and Lions Cord Blood Foundation. Atul Malhotra’s research is supported by multiple sources including NHMRC (Australia) and Cerebral Palsy Alliance (Australia).

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  1. Department of Paediatrics, Monash University, Melbourne, VIC, Australia

    Abdul Razak & Atul Malhotra

  2. Monash Newborn, Monash Children’s Hospital, Melbourne, VIC, Australia

    Abdul Razak & Atul Malhotra

  3. The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia

    Abdul Razak & Atul Malhotra

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  1. Abdul Razak
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Both authors contributed to the initial draft, editing and final approval of commentary.

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Correspondence to Atul Malhotra.

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Razak, A., Malhotra, A. Fetal inflammatory response spectrum: mapping its impact on severity of necrotising enterocolitis. Pediatr Res 95, 1179–1180 (2024). https://doi.org/10.1038/s41390-023-02973-9

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