The main route of mother-to-child transmission (MTCT) of human T cell leukemia virus type 1 is vertical transmission via breastfeeding. Although the most reliable method for preventing MCTC is exclusive formula feeding (ExFF), short-term breastfeeding (STBF) or frozen–thawed breast milk feeding (FTBMF) has been offered as an alternative method if breastfeeding is strongly desired. The aim of this review was to clarify the pooled risk ratio of MCTC of STBF and FTBMF compared with ExFF. This study was registered with PROSPERO (number 42018087317). A literature search of PubMed, CINAHL, the Cochrane Database, EMBASE, and Japanese databases through September 2018 identified 1979 articles, 10 of which met the inclusion criteria. Finally, 11 articles, including these 10 studies and the report of a recent Japanese national cohort study, were included in the meta-analysis. The pooled relative risks of STBF ≤3 months, STBF ≤6 months, and FTBMF compared with ExFF were 0.72 (95% confidence interval (CI): 0.30–1.77; p = 0.48), 2.91 (95% CI: 1.69–5.03; p = 0.0001), and 1.14 (95% CI: 0.20–6.50; p = 0.88), respectively. This meta-analysis showed no statistical difference in the risk of MTCT between STBF ≤3 months and ExFF, but the risk of MTCT significantly increased in STBF ≤6 months.

Pulmonary hypertension (PH) with bronchopulmonary dysplasia (BPD) is fraught with high infant mortality rates. However, the intervention strategy for severe PH is unclear. This case report discusses the utility of long-term high-dose inhaled nitric oxide (iNO) administration and that of oxygen therapy for the prevention of PH deterioration. A male infant weighing 864 g was delivered at a gestational age of 24 weeks and three days. The patient who had severe BPD was diagnosed with PH at a corrected gestational age (CGA) of 43 weeks. Although oxygen was administered to prevent PH, the patient still developed severe PH. Despite long-term high-dose (iNO) administration, the patient could not survive. The abovementioned treatment may exacerbate PH, and oxygen administration is less effective for the prevention of PH deterioration with BPD.

Differential cyanosis indicates a lower percutaneous oxygen saturation （SpO2） level in the lower extremities than in the upper extremities and is generally observed in patients with interrupted aortic arch （IAA）. We report a case of the absence of differential cyanosis in a neonate with IAA. A male neonate was born at 38weeks of gestation. Despite routine care, his SpO2 level dropped to 90％ at 1h after birth. On admission, there was no evidence of differential cyanosis. Systolic murmur was noted 12h after birth, leading to suspicion of IAA on echocardiography; IAA type B was confirmed by computed tomography. IAA type B occurs between the left carotid artery and left subclavian artery. In our patient, the levels of SpO2 were different between the ear and lower extremities without signs of differential cyanosis because his right subclavian artery branched from the aorta distal to the interruption and left subclavian artery. In conclusion, despite the absence of differential cyanosis and lack of detailed echocardiographic evaluation, careful observation is mandatory. SpO2 measurement in the ear is important to rule out IAA.

As uniformly fortified human milk does not provide sufficient nutrition to ensure the optimal growth of preterm infants, individualized fortification （IF） is required. Two types of IF exist, including adjustable fortification （Adj F）, based on blood urea nitrogen levels, and targeted fortification （Targ F）, based on an analysis of the protein content in human milk. We aimed to clarify the effectiveness, ease, safety, and complications for very-low-birth-weight infants （VLBWIs） by comparing Adj F with Targ F in a neonatal intensive care unit. This is a randomized controlled study. VLBWIs were randomly divided into the Adj F （n＝23） and Targ F （n＝22） groups. The anthropometric data of corrected age, growth velocity, and plasma aminograms at 37 weeks were compared between the groups. The median gestational ages were 29.0 and 28.7 weeks in the Adj F and Targ F groups, respectively. In both groups, the first day of individualized human milk fortification was 7 days following full-strength fortification initiation. The anthropometric data, growth velocity, complications, and aminograms were not significantly different between the groups, nor were the plasma amino acid levels. The average nutritional protein and energy intake exhibited no difference between the groups. The Adj F and Targ F methods demonstrated comparable findings regarding anthropometric data, growth velocity, and plasma amino acids. Therefore, IF method may be selected on the basis of institutional protocols and feasibility.

Mother's milk (MOM) provides numerous benefits for very preterm infants; however, it requires fortification to achieve appropriate nutrition intake. Although cow milk-based human milk fortifier (CMHMF) is widely used in Japan, it poses a risk of fatty acid calcium formation in infants with ileostomy. An exclusive human milk diet (EHMD) uses only human milk products to fortify MOM or donor human milk using a human milk-based human milk fortifier. Compared to CMHMF, EHMD reduces feeding intolerance and necrotizing enterocolitis in premature infants and may be safely used in infants with an ileostomy. However, specific studies addressing the nutritional effects of EHMD in these patients are lacking. This case report discusses the potential benefits of an EHMD in an infant undergoing ileostomy. The male infant, weighing 742 g, was delivered by emergency cesarean section at the postmenstrual age of 26 weeks and three days. On day eight of life, the patient underwent intestinal resection and anastomosis for a localized intestinal perforation. CMHMF could not be used because of the risk of fatty acid calcium stone formation. Given concerns regarding malnutrition, the case was administered an EHMD. Following the introduction of EHMD, his weight gain improved from 5 g/day to 17 g/day, and his z-score improved from -0.8 standard deviation (SD) to +0.3 SD. No adverse events were observed. It is suspected that the improvement in the anthropometric data was attributable to the establishment and maintenance of full feeding volumes alongside the EHMD, which ensured adequate nutrition and increased nutritional intake. This case suggests that EHMD may be a safe and effective nutritional strategy to promote optimal growth and development in infants undergoing abdominal surgery.