Metabolomics: a new tool for the neonatologist.

Metabolomics enables the parallel assessment of the levels of a broad range of metabolites and has been shown to have a great impact in investigation of physiological status, diagnosing diseases, measuring the response to treatment, discovering biomarkers, identifying perturbed pathways due to disease or treatment, functional genomics. Common analytical techniques applied to metabolomics are nuclear magnetic resonance spectroscopy, gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry. The most commonly used biological samples for metabolomics studies are urine, blood plasma or serum. Because of its characteristics and simple non-invasive methods of collection, urine is particularly suited for metabolomic analysis even in small babies. The use of non-invasive techniques is an essential requirement in neonatal medicine, especially in very preterm infants. Little is known about the overall metabolic status of the term and preterm neonate, but it can be currently assessed by metabolomic analysis of urine. Other important applications of metabolomic analysis of urine in the newborn could be the monitoring of postnatal metabolic maturation over time, the identification of biomarkers as early predictors of outcome, and the implementation and monitoring of a tailored management of neonatal disorders. The clinical management of neonates could be probably improved if more information about perinatal and neonatal maturation processes and their metabolic background were available. The metabolomics approach, together with transcriptomics and proteomics, will have substantial impact on development of diagnostics, therapeutics and drug development and may be an important new tool in neonatology.