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Bowel problems in newborns – improving diagnosis of necrotising enterocolitis

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Each year in the UK, up to 3,000 babies develop a serious bowel problem called necrotising enterocolitis.1 Sadly, up to 35 per cent of these babies die and survivors often develop long-term health problems.1,2 The disease typically strikes without warning. By the time it is diagnosed, babies are often already extremely ill. Researchers are developing a new diagnostic test, which could allow babies with the disease to be identified and treated sooner. They hope this will reduce the likelihood of the disease progressing and therefore limit the devastating consequences.


What's the problem and who does it affect?

A sudden, unpredictable and often lethal illness

Necrotising enterocolitis (NEC) is a devastating bowel disorder that mainly strikes premature babies. Around three per cent of newborns in neonatal units develop the disorder.2 Sadly, up to 35 per cent of these babies die.1,2 The numbers are even higher in babies who are born extremely early.2

Doctors and nurses must be constantly on the lookout for symptoms of NEC, as premature babies in neonatal units can develop the disease at any time, with little or no warning. Difficulties with diagnosis mean NEC is often identified late, when a baby is already extremely ill. No test can reliably identify babies in the early stages of the disease.

Babies who develop NEC can need emergency surgery to remove damaged parts of their intestines. Up to half of babies who survive the disease develop health problems.3 Some fail to put on weight properly, they can develop serious infections and liver damage, and nutritional problems can mean they have to be fed through a tube that goes directly into their bloodstream. Babies can also develop significant hearing, vision and movement problems. NEC remains a threat to premature babies. Improved diagnosis and treatment are urgently needed.


What is the project trying to achieve?

An exciting discovery that could lead to earlier diagnosis

In earlier work, the researchers made an exciting discovery, which they believe could lead to a major breakthrough in the diagnosis of NEC. They found preliminary evidence that suggests the composition of a baby’s faeces changes in a characteristic way if he, or she, develops NEC. The researchers think that these changes begin early in the disease process, before the baby experiences any obvious symptoms. The researchers’ findings come from a small study involving 58 premature babies, 6 of whom developed NEC.

The researchers now want to study a larger group of up to 1,200 premature babies, who were all born at least six weeks early. They are finding out more about exactly how the composition of the babies’ faeces changes over time, and whether they can use these changes to identify babies who are in the early stages of NEC.

As part of this DOVE study, which stands for ‘Diagnosing testing of Organic Volatiles in necrotising Enterocolitis’, the team is developing a special piece of equipment, a sensor, which could allow earlier diagnosis of NEC. The sensor works by detecting gases – or, more specifically, volatile organic compounds – that are emitted by babies’ faeces early in the disease process.

What are the researchers' credentials?


Highly experienced researchers from three universities – Birmingham, Bristol and the University of the West of England – are collaborating on this project.

The project leader, Dr Andrew Ewer, will oversee the clinical aspects of the study in Birmingham – recruiting babies to take part in the study, from five neonatal units in the West Midlands, collecting samples and gathering data on the babies’ health. The neonatal units involved have a very good track record of recruiting large numbers of babies to studies – over 20,000 babies were recruited to Dr Ewer’s last study, which examined screening for congenital heart disease.

Researchers at the other two universities, which are both in Bristol, are undertaking the laboratory work. They have cutting-edge skills in analysing the complex mixture of gases emitted by faeces and are very experienced in the statistical analysis of vast data sets, like the ones that are being generated in this study.

The researchers have already collaborated successfully, on the preliminary investigation that led to the discovery that NEC is associated with characteristic changes in babies’ faeces. Their pilot data has been published in a well-respected journal.4

Who stands to benefit from this research and how?

Helping babies before they become seriously ill

The researchers aim to help premature babies who are at risk of developing NEC, a serious, often lethal bowel condition that tends to strike without warning.

The researchers are designing a new sensor, which could allow screening of premature babies for NEC to become routine – for the first time ever. The researchers believe the new sensor could allow much earlier diagnosis of NEC, so that babies with the disease can be identified and treated sooner, before they become seriously ill.

The design of the sensor should mean it is suitable for regular use alongside babies’ cots in neonatal units. If the results of this project are positive, then clinical trials would follow.

Around 3,000 babies develop NEC each year in the UK.1 Sadly, around 35 per cent of these babies die and up to half of survivors develop ongoing health problems, which can persist for life.1,3 Clearly any reduction in these devastating statistics, which earlier diagnosis and treatment might ultimately bring, would benefit both babies and their parents.


  1. Rees CM, Eaton S, Pierro A. Trends in infant mortality from necrotising enterocolitis in England and Wales and the USA. Arch Dis Child Fetal Neonatal Ed 2008; 93: F395-6.
  2. Statnikov Y, Santhakumaran S, Manktelow B, Modi N (on behalf of the Neonatal Data Analysis Unit). Surveillance of necrotising enterocolitis in England, Neonatal Society Abstracts, The Neonatal Society. Website accessed 16 March 2011: http://www.neonatalsociety.ac.uk/abstracts/statnikovy_2010_necsurveillance.shtml
  3. Schulzke S, Deshpande G, Patole S. Neurodevelopmental outcomes of very low-birth-weight infants with necrotizing enterocolitis: a systematic review of observational studies. Arch Pediatr Adolesc Med 2007; 161(6):583-90.
  4. Garner CE, Ewer AK, Elasouad K, Power F, Greenwood R, Ratcliffe NM, de Lacy Costello B, Probert CS. Analysis of faecal volatile organic compounds in preterm infants who develop necrotising enterocolitis: a pilot study. Journal of Pediatric Gastroenterology and Nutrition 2009;49:559-565.


Project Leader Dr Andrew K Ewer MD MRCP FRCPCH
Project Team Professor Christopher SJ Probert MD FRCP FHEA Ms Rosemary Greenwood MScProfessor Norman M Ratcliffe PhDDr Ben de Lacy Costello PhD
Project Location Neonatal Unit, Birmingham Women's Hospital, University of Birmingham in conjunction with the School of Clinical Sciences, Bristol Royal Infirmary, the University Hospitals Bristol NHS Foundation Trust and the Faculty of Health and Life Sciences, Centre for Research in Analytical Material and Sensor Sciences, University of the West of England, Bristol
Project Location Other School of Clinical Sciences, Bristol Royal InfirmaryDepartment of Gasroenterology, Institute of Translational Medicine, University of LiverpoolFaculty of Health and Life Sciences, Centre for Research in Analytical Material and Senser Sciences, University of the West of England, BristolRoyal Hallamshire Hospital, SheffieldLeicester Royal Infirmary
Project duration 2.5 years
Date awarded 19 November 2010
Project start date 23 November 2011
Project end date 30 September 2016
Grant amount £131,638
Grant code SP4588, GN1788
Acknowledgements This project supported by a generous grant from The Henry Smith Charity.


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