title: Early Detection of Necrotizing Enterocolitis by Fecal Volatile Organic Compounds Analysis.
abstract: OBJECTIVE
  To test the hypothesis that fecal volatile organic compounds (VOCs) analysis by electronic nose (eNose) allows for early detection of necrotizing enterocolitis (NEC).
  
  
  METHODS
  In 3 neonatal intensive care units, fecal samples of infants born at gestational age ≤ 30 weeks were collected daily, up to the 28th day of life. Included infants were allocated in 3 subgroups: NEC, sepsis, and matched controls. Three time windows were defined: (1) T-5,-4 (5 and 4 days before diagnosis); (2) T-3,-2 (3 and 2 days before diagnosis); and (3) T-1,0 (day before and day of diagnosis). Three subgroups were analyzed by eNose.
  
  
  RESULTS
  Fecal VOC profiles of infants with NEC (n = 13) could significantly be discriminated from matched controls (n = 14) at T-3,-2 (area under the curve ± 95% CI, P value, sensitivity, specificity: 0.77 ± 0.21, P = .02, 83%, 75%); the accuracy increased at T-1,0 (0.99 ± 0.04, P ≤ .001, 89%, 89%). VOC profiles of infants with NEC were also significantly different from those with sepsis (n = 31) at T-3,-2 (0.80 ± 0.17, P = .004, 83%, 75%), but not at T-1,0 (0.64 ± 0.18, P = .216, 89%, 57%).
  
  
  CONCLUSIONS
  In this proof of principle study, we observed that fecal VOC profiles of infants with NEC could be discriminated from controls, from 2-3 days predating onset of clinical symptoms. Our observations suggest that VOC-profiling by eNose has potential as a noninvasive tool for the early prediction of NEC.
authors.affiliation: Department of Pediatric Gastroenterology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Tim G J
authors.initials: TG
authors.lastname: de Meij
authors.affiliation: Department of Pediatric Pulmonology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc P C
authors.initials: MP
authors.lastname: van der Schee
authors.affiliation: Department of Pediatric Gastroenterology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Daan J C
authors.initials: DJ
authors.lastname: Berkhout
authors.affiliation: Department of Pediatric Gastroenterology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mirjam E
authors.initials: ME
authors.lastname: van de Velde
authors.affiliation: Department of Pediatric Gastroenterology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Jansen
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Boris W
authors.initials: BW
authors.lastname: Kramer
authors.affiliation: Neonatal Intensive Care Unit, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mirjam M
authors.initials: MM
authors.lastname: van Weissenbruch
authors.affiliation: Neonatal Intensive Care Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Anton H
authors.initials: AH
authors.lastname: van Kaam
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands; Neonatal Intensive Care Unit, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Andriessen
authors.affiliation: Neonatal Intensive Care Unit, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: hendrik.niemarkt@mumc.nl.
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Niemarkt
authors.affiliation: Department of Gastroenterology and Hepatology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Nanne K H
authors.initials: NK
authors.lastname: de Boer
mesh_terms: D042241:Early Diagnosis; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D013997:Time Factors; D055549:Volatile Organic Compounds / Q000032:analysis*
chemical_list: D055549:Volatile Organic Compounds