A New Way of Predicting Preemies at Risk
A premature baby’s saliva could hold enough clues to predict whether that infant is at risk for death, infectious diseases and necrotizing
enterocolitis (NEC), the most common gastrointestinal emergency in the neonatal intensive care unit.
Cincinnati Children’s is the leader of a nearly $3 million, five-year grant from the National Institute of Child Health and Human Development studying sugar in the saliva of babies with extremely low birth weights. The sugars are considered novel biomarkers for predicting risk of NEC and related problems.
“Fundamentally, necrotizing enterocolitis is a kind of disease that is a major emergency of the gastrointestinal tract,” says Ardythe L. Morrow, PhD, the study’s lead researcher. “You get extreme inflammation. It can kill babies fairly rapidly. The baby’s looking fine, and suddenly it looks like he’s dying.”
This may be the first major biomarker for risk of NEC, sepsis and death ever discovered in premature infants, she says.
NEC, which causes intestinal tissue to die, develops in only 2,000 to 4,000 newborns a year in the United States. But it affects up to 8 percent of newborns admitted to the NICU. Up to half of those babies end up in surgery, and while many survive and go on to live healthy lives, others have gastrointestinal problems for life because of serious damage or holes in the intestinal tissue.
“It’s a devastating problem,” says Morrow, who hopes measuring sugars in a baby’s saliva will lead to early diagnosis and treatment.
Researchers are particularly interested in how the sugars in a baby’s saliva are structured and whether they have “secretor sugars” that infectious agents like to bind to.
It’s like blood group typing. Investigators hypothesize that if the baby has a secretor-type sugar structure, the secretor sugar also is on the soft surface of the baby’s intestine, where germs like to bind and start infections – which would put those babies at higher risk of diarrheal disease. If the baby is fed breast milk and the mother’s milk contains secretor sugar structures, the organisms would bind to the mother’s milk structure instead of the baby’s.
That’s a significant discovery, Morrow says, because it predicts who is at risk. “It could have huge implications. It could be developed as a whole new line of defense.”
The next step is for investigators to determine which organisms bind to specific sugars. They’re working to identify babies who may be more genetically at risk of certain infections.
Their research may lead to routine diagnostic testing of baby’s saliva. Morrow says it could also give parents peace of mind.
“It could be a relief to parents to know their baby is considered to be in a protected genetic state,” she says.
The research could provide new tools for monitoring premature babies.
“In the research arena, people have been largely focused on protein markers of various kinds. This is not protein. This is carbohydrate,” Morrow says. “So that’s a whole new dimension of medicine.”
