Untargeted cord blood metabolomics reveals altered lipid metabolism in neonates with gastroschisis

Abstract

Gastroschisis is a congenital abdominal wall defect in which fetal intestines herniate into the amniotic cavity. Despite 97% surgical repair success rate, 40% of affected infants require hospital readmission due to gastrointestinal complications, where underlying mechanisms remain poorly characterized. We hypopthesized that the cord blood metabolome of neonates with gastroschisis differs systematically from controls and may reveal pathway-level alterations relevant to neonatal physiology. Cord blood plasma collected at delivery (23 samples each group) was analyzed using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Unsupervised principal component analysis and hierarchical clustering demonstrated significant separation between groups (PERMANOVA pseudo-F = 4.632, R{superscript 2} = 0.095, p = 0.001). 53 metabolites met criteria for differential abundance, 75% were lipids. Key alterations included reduced free fatty acids, increased fatty acid amides and ceramides, disrupted steroid and bile acid metabolism, and decreased biliverdin and bilirubin isomers. Our findings provide insight into gastroschisis pathophysiology and identify potential biomarkers for future investigation.