Prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis, neonatal diabetes mellitus and exocrine pancreatic insufficiency: a case report
Abstract Background Necrotizing enterocolitis (NEC) is a serious complication predominantly affecting very low birth weight neonates, characterized by high mortality and long-term morbidity. Neonatal diabetes mellitus (NDM) is a rare condition with diverse etiologies, including genetic predispositio...
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2025-07-01
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| Series: | Italian Journal of Pediatrics |
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| Online Access: | https://doi.org/10.1186/s13052-025-02021-8 |
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| author | Pasquale Castaldo Luigi Altimari Maria Grazia Capretti Giulio Maltoni Andrea Scozzarella Vittoria Paoletti Luigi Corvaglia Arianna Aceti |
| author_facet | Pasquale Castaldo Luigi Altimari Maria Grazia Capretti Giulio Maltoni Andrea Scozzarella Vittoria Paoletti Luigi Corvaglia Arianna Aceti |
| author_sort | Pasquale Castaldo |
| collection | DOAJ |
| description | Abstract Background Necrotizing enterocolitis (NEC) is a serious complication predominantly affecting very low birth weight neonates, characterized by high mortality and long-term morbidity. Neonatal diabetes mellitus (NDM) is a rare condition with diverse etiologies, including genetic predisposition and autoimmune mechanisms. To our knowledge, NEC and NDM have never been previously reported together. Case presentation We report the clinical case of a late preterm infant whose mother had received an immune checkpoint inhibitor treatment (pembrolizumab) for metastatic gastric cancer during pregnancy. The infant suffered from severe and recurrent necrotizing enterocolitis (NEC), neonatal diabetes mellitus (NDM) and exocrine pancreatic insufficiency that required a multidisciplinary approach. Prenatal exposure to pembrolizumab might explain the co-occurrence of the three diseases and the complex and unusual medical history of the child, even if the possibility that these events were independent of each other cannot be totally ruled out. Conclusion This case suggests the potential association between antenatal pembrolizumab exposure and severe neonatal comorbidities. Furthermore, it highlights the challenge of managing concurrent NEC, NDM and exocrine pancreatic insufficiency in early infancy, emphasizing the need for multidisciplinary care and long-term follow-up to address complex clinical and developmental outcomes. |
| format | Article |
| id | doaj-art-7fb6d690fb9f4229b9ecd3601f0c5da8 |
| institution | DOAJ |
| issn | 1824-7288 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Italian Journal of Pediatrics |
| spelling | doaj-art-7fb6d690fb9f4229b9ecd3601f0c5da82025-08-20T03:05:11ZengBMCItalian Journal of Pediatrics1824-72882025-07-015111610.1186/s13052-025-02021-8Prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis, neonatal diabetes mellitus and exocrine pancreatic insufficiency: a case reportPasquale Castaldo0Luigi Altimari1Maria Grazia Capretti2Giulio Maltoni3Andrea Scozzarella4Vittoria Paoletti5Luigi Corvaglia6Arianna Aceti7School of Specialization in Pediatrics, Department of Medical and Surgical Sciences, University of BolognaSchool of Specialization in Pediatrics, Department of Medical and Surgical Sciences, University of BolognaNeonatal Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di BolognaPediatric Unit, IRCCS AOU BolognaPediatric Unit, IRCCS AOU BolognaNeonatal Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di BolognaSchool of Specialization in Pediatrics, Department of Medical and Surgical Sciences, University of BolognaSchool of Specialization in Pediatrics, Department of Medical and Surgical Sciences, University of BolognaAbstract Background Necrotizing enterocolitis (NEC) is a serious complication predominantly affecting very low birth weight neonates, characterized by high mortality and long-term morbidity. Neonatal diabetes mellitus (NDM) is a rare condition with diverse etiologies, including genetic predisposition and autoimmune mechanisms. To our knowledge, NEC and NDM have never been previously reported together. Case presentation We report the clinical case of a late preterm infant whose mother had received an immune checkpoint inhibitor treatment (pembrolizumab) for metastatic gastric cancer during pregnancy. The infant suffered from severe and recurrent necrotizing enterocolitis (NEC), neonatal diabetes mellitus (NDM) and exocrine pancreatic insufficiency that required a multidisciplinary approach. Prenatal exposure to pembrolizumab might explain the co-occurrence of the three diseases and the complex and unusual medical history of the child, even if the possibility that these events were independent of each other cannot be totally ruled out. Conclusion This case suggests the potential association between antenatal pembrolizumab exposure and severe neonatal comorbidities. Furthermore, it highlights the challenge of managing concurrent NEC, NDM and exocrine pancreatic insufficiency in early infancy, emphasizing the need for multidisciplinary care and long-term follow-up to address complex clinical and developmental outcomes.https://doi.org/10.1186/s13052-025-02021-8Necrotizing enterocolitisNeonatal diabetes mellitusPembrolizumabCase reportMaternal immune checkpoint inhibitor therapy |
| spellingShingle | Pasquale Castaldo Luigi Altimari Maria Grazia Capretti Giulio Maltoni Andrea Scozzarella Vittoria Paoletti Luigi Corvaglia Arianna Aceti Prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis, neonatal diabetes mellitus and exocrine pancreatic insufficiency: a case report Italian Journal of Pediatrics Necrotizing enterocolitis Neonatal diabetes mellitus Pembrolizumab Case report Maternal immune checkpoint inhibitor therapy |
| title | Prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis, neonatal diabetes mellitus and exocrine pancreatic insufficiency: a case report |
| title_full | Prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis, neonatal diabetes mellitus and exocrine pancreatic insufficiency: a case report |
| title_fullStr | Prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis, neonatal diabetes mellitus and exocrine pancreatic insufficiency: a case report |
| title_full_unstemmed | Prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis, neonatal diabetes mellitus and exocrine pancreatic insufficiency: a case report |
| title_short | Prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis, neonatal diabetes mellitus and exocrine pancreatic insufficiency: a case report |
| title_sort | prenatal pembrolizumab exposure as the potential link among recurrent necrotizing enterocolitis neonatal diabetes mellitus and exocrine pancreatic insufficiency a case report |
| topic | Necrotizing enterocolitis Neonatal diabetes mellitus Pembrolizumab Case report Maternal immune checkpoint inhibitor therapy |
| url | https://doi.org/10.1186/s13052-025-02021-8 |
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