Feeding preterm infants with mother’s own milk is associated with a reduction in postnatal complications and an improved neurocognitive outcome. Therefore, the bioactive factor composition of human milk has been used as a tool for the development of nutritional supplements with a potential prophylactic or therapeutic effect. The aim of this systematic review was to provide an overview on bioactive factors which have been studied as supplement to enteral nutrition in randomized controlled trials, and to provide an overview of ongoing trials. MEDLINE, EMBASE, CENTRAL, and clinical trial registers were searched. Studies on the antimicrobial protein lactoferrin were excluded as these were summarized very recently in three separate systematic reviews. Studies on vitamins D, K and iron were also excluded as they are already incorporated in most international guidelines. We identified 17 different bioactive factors, which were investigated in 26 studies. Despite the encouraging potential effects of several bioactive factors, more high-quality studies with a sufficient number of preterm infants are required before a certain factor may be implemented into clinical practice. Three large trials (n > 500) that investigate the effects of either enteral insulin or vitamin A are currently ongoing and could provide more definite answers on these specific supplements.

Donor human milk (DHM) is recommended as the first alternative for preterm infants if their mother's own milk is not available or if the quantity is not sufficient. The most commonly used technique to eliminate microbial contaminants in DHM is holder pasteurization (HoP). However, the heating process during HoP partially destroys milk bioactive factors such as insulin. Therefore, innovative techniques have been developed as alternatives to HoP. The objective of this study was to determine the effect of HoP, high-temperature-short-time (HTST), thermoultrasonication (TUS), ultraviolet-C irradiation (UV-C), and high-pressure processing (HPP) on the insulin concentration in DHM. Milk samples from 28 non-diabetic mothers were collected. The milk samples were aliquoted and either left untreated or treated with HoP (62.5 °C; 30 min), HTST (72 °C; 15 s), TUS (60 W; 6 min), UV-C (4863 J/L), or HPP (500 MPa; 5 min). The mean insulin concentration in untreated milk was 79 ± 41 pmol/L. The mean insulin retention rate was 67% for HoP, 78% for HTST, 97% for TUS, 94% for UV-C, and 106% for HPP. The mean insulin concentration in milk treated with HoP was significantly lower compared to untreated milk (p = 0.01). TUS, UV-C, and HPP preserve insulin in DHM. The insulin concentration in DHM is affected to a larger extent by HoP than by HTST. These results indicate that TUS, UV-C, and HPP may serve as alternatives to HoP.

Background: Children with intestinal failure who are receiving parenteral nutrition through a central venous catheter are at risk of developing catheter-related bloodstream infections. For many years, a prophylactic lock with taurolidine has been used to decrease the incidence of these infections and is considered safe in children. Case Presentation: A 1-month-old boy with jejunal atresia was receiving parenteral nutrition through a central venous catheter. Shortly after administration of taurolidine (TauroSept®), he developed circulatory insufficiency and angioedema. His serum tryptase increased, which was suggestive of anaphylaxis (baseline tryptase 6.3 µg/L; 2 h after start of the reaction: 21 µg/L; cutoff criterion for clinically relevant increase: 1.2 × baseline tryptase level + 2). Conclusions: To the best of our knowledge, this is the first case of anaphylaxis in response to TauroSept® in an infant worldwide. Clinicians should be aware of this possible but very rare side effect.

Microcephaly, characterized by crania with an abnormally small occipitofrontal circumference (OFC), is only sporadically described in paleopathological literature. Accurate identification of individuals suffering from microcephaly is challenging when performed in an archeological context, especially in mild cases, as appropriate reference data are often not available. This study aimed to describe the craniometric characteristics of the Meerenberg (MeB) skeletal collection and to identify microcephalic individuals while focusing on the diagnostic criteria and the influence of reference data on the prevalence of the condition. The value of virtual endocasts as a diagnostic tool was also assessed. Forty‐eight adults (1891–1936) excavated from the cemetery of the MeB psychiatric hospital (Bloemendaal, The Netherlands) were investigated. Microcephalic individuals were identified by using the craniometric characteristics of a contemporary Dutch archeological population as reference. In order to investigate the usefulness of modern clinical head circumference reference data on the diagnostic process, cranial OFCs of the MeB individuals were converted to head OFCs. Virtual endocasts were created from the identified microcephalics and three normocephalics. Three MeB females (all <−3 SD) were identified as microcephalic when compared with a sex‐matched contemporary archeological reference sample. The same three MeB females were classified as microcephalic when using sex‐matched modern clinical reference data and when applying −3 SD of the pooled sex archeological craniometric reference data as cut‐off point. No individuals were classified as microcephalic based on the metric characteristics of the virtual endocasts. Microcephaly can only be accurately identified when using sex‐matched contemporary population reference data, or in its absence, modern clinical data after soft tissue correction. Should sex estimation be unreliable, a –3 SD cut‐off point generated using pooled sex reference data seems suitable as diagnostic tool. Virtual endocast did not support the identification of microcephaly in this study.