Human milk is a dynamic source of nutrients and bioactive factors; unique in providing for the human infant’s optimal growth and development. The growing infant’s immune system has a number of developmental immune deficiencies placing the infant at increased risk of infection. This review focuses on how human milk directly contributes to the infant’s innate immunity. Remarkable new findings clarify the multifunctional nature of human milk bioactive components. New research techniques have expanded our understanding of the potential for human milk’s effect on the infant that will never be possible with milk formulas. Human milk microbiome directly shapes the infant’s intestinal microbiome, while the human milk oligosaccharides drive the growth of these microbes within the gut. New techniques such as genomics, metabolomics, proteomics, and glycomics are being used to describe this symbiotic relationship. An expanded role for antimicrobial proteins/peptides within human milk in innate immune protection is described. The unique milieu of enhanced immune protection with diminished inflammation results from a complex interaction of anti-inflammatory and antioxidative factors provided by human milk to the intestine. New data support the concept of mucosal-associated lymphoid tissue and its contribution to the cellular content of human milk. Human milk stem cells (hMSCs) have recently been discovered. Their direct role in the infant for repair and regeneration is being investigated. The existence of these hMSCs could prove to be an easily harvested source of multilineage stem cells for the study of cancer and tissue regeneration. As the infant’s gastrointestinal tract and immune system develop, there is a comparable transition in human milk over time to provide fewer immune factors and more calories and nutrients for growth. Each of these new findings opens the door to future studies of human milk and its effect on the innate immune system and the developing infant.

A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.

Background: Feeding neonates with CHD is clinically and emotionally challenging. Although human milk improves outcomes—including reduced necrotising enterocolitis, sepsis, and neurodevelopmental delays—its use remains suboptimal. Prior studies have focused on clinical endpoints, with limited attention to modifiable maternal or prenatal influences on feeding. Objective: To evaluate how maternal expectations, prenatal counselling, and early lactation behaviours affect feeding outcomes in infants with prenatally diagnosed CHD. Methods: We conducted a prospective cohort study of 49 mother–infant dyads with prenatally diagnosed CHD in a tertiary neonatal ICU and paediatric cardiac ICU. Mothers completed structured surveys during hospitalisation. Feeding outcomes were assessed through chart review over six months post-discharge. Primary outcomes included human milk volume at day of life 14, feeding type at discharge, and direct breastfeeding. Multivariable logistic regression and CHD risk stratification were used for analysis. Results: Direct breastfeeding during hospitalisation predicted oral feeding at discharge (77% vs. 28%, p = 0.0006) and ongoing human milk use. Early milk exposure (<72 hours) increased likelihood of human milk use at discharge ( p = 0.0158). Strong maternal intent and prior breastfeeding experience were linked to sustained lactation. Prenatal counselling (reported by 68%) was not associated with outcomes. Higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery scores correlated with delayed achievement of 500 mL/day by day of life 14 ( p = 0.0405). Conclusions: Direct breastfeeding, early milk exposure, and maternal intent are key modifiable drivers of feeding success in neonates with CHD. Standard prenatal counselling alone is insufficient. Targeted, risk-informed lactation support is needed to optimise outcomes.

Background Gastroschisis is a congenital abdominal wall defect characterized by severe gut dysmotility. These neonates often face lengthy hospital stays, prolonged parenteral nutrition dependence, and complications such as growth faltering, sepsis, and intestinal failure. Feeding practices for neonates with gastroschisis vary and emphasize extended bowel rest and delayed feeding initiation. However, emerging studies suggest that early initiation of feeds through standardized protocols may improve outcomes. The Gastroschisis And Early Infant Nutrition (GAIN) Study aims to test the feasibility of an early feeding approach in neonates with simple gastroschisis. Methods This two-site single-arm feasibility trial aims to enroll neonates with presumed simple gastroschisis over 30 months. The intervention has two main components: Replogle suction tube removal within 24 hours of abdominal closure and starting small-volume human milk feeds within 48 hours of abdominal closure. Feeding volume will be advanced as tolerated, following the University of California Fetal Consortium pathway, which is standard care. Feasibility outcomes include enrollment rate, protocol adherence, fidelity, and withdrawal rate. Exploratory outcomes include hospitalization length, time to full feeds, duration of parenteral nutrition, use of human milk, breastfeeding rates, and anthropometric measurements. Safety measures involve monitoring for feeding-related complications, infections, and unexpected surgical interventions. Discussion This feasibility trial of early feeding initiation in neonates with gastroschisis is a critical step towards addressing the need for a standardized feeding approach. Findings will inform future clinical trials and challenge the need for prolonged bowel rest. Standardizing early feeding practices could reduce practice variation, improve gut motility, and the overall health of neonates with gastroschisis. Trial registration : This feasibility trial is registered on ClinicalTrials.gov (NCT number: NCT06878950, https://clinicaltrials.gov/study/NCT06878950). Date of registration 3/10/2025 Retrospectively registered.

Introduction: An adequate supply of a mother’s own milk plays a critical role in optimising health outcomes for at-risk hospitalised infants. Insufficient milk production disproportionately affects the mothers of these infants. In the USA, metoclopramide is the only approved drug available for off-label use as a galactagogue. Nicotinamide riboside (NR), a direct precursor to nicotinamide adenine dinucleotide (NAD ⁺ ), has been shown in a murine model to augment high-quality milk production and enhance cognitive and physical development of pups. Human testing with NR has been limited, and studies in lactating individuals have not been performed. The aim of this study is to assess the feasibility of NR supplementation in mothers whose infants are admitted to the neonatal intensive care unit (NICU) for at least 4 weeks. Method and analysis: This double-blind, randomised, placebo-controlled pilot feasibility trial aims to investigate NR supplementation in mothers of infants who are anticipated to be hospitalised in the NICU for at least 4 weeks. We plan to enroll 40 mother–infant pairs with the expectation that 30 will complete the study (n=15 in each group). The intervention period with maternal NR supplementation or placebo supplementation and maternal milk, urine and blood sampling will be 19 days, including an enrollment day. The primary endpoint of the study includes feasibility of enrolling ≥50% of eligible mothers. Secondary endpoints include compliance, adherence or withdrawal from the protocol. Similarly, the study will assess the difference in mean milk volume, macronutrient and micronutrient content, human milk glycans, milk and urine metabolites and infant feeding practice between the two groups. Optional secondary endpoints include differences in serum prolactin, liver function, plasma lipidome, serum metabolites, serum cellular communication network factor 3 concentrations, serum NAD ⁺ -related precursors and intermediates between mothers of the two groups. Exploratory outcomes include changes in mothers’ weight and infants’ developmental and NICU outcomes. Safety endpoints include the frequency of adverse events. Ethics and dissemination: The Institutional Review Board (IRB) protocol version date is 1 June 2026, approved by the IRB at the University of California Davis Medical Center (approval number: 1557473). Study investigators will communicate trial results to participants, healthcare professionals and the public through peer-reviewed publications and presentations at scientific conferences. Trial results will also be reported on ClinicalTrials.gov and made available through PubMed Central, in accordance with regulatory requirements. Deidentified participant data will be available to qualified researchers upon request after publication. Approved requests will be granted access within 12 months and are subject to study team and IRB approval and a data use agreement. Trial registration number: NCT04614714 .