Human milk oligosaccharides (HMOs) stimulate the growth of gut commensals, prevent the adhesion of enteropathogens and modulate host immunity. The major factors influencing variations in the HMO profile are polymorphisms in the secretor (Se) or Lewis (Le) gene, which affect the activity of the enzymes fucoslytransferase 2 and 3 (FUT2 and FUT3) that lead to the formation of four major fucosylated and non-fucosylated oligosaccharides (OS). This pilot study aimed to determine the HMO profile of Israeli breastfeeding mothers of 16 term and 4 preterm infants, from a single tertiary center in the Tel Aviv area. Fifty-two human milk samples were collected from 20 mothers at three-time points: colostrum, transitional milk and mature milk. The concentrations of nine HMOs were assessed using liquid chromatography coupled with mass spectra chromatograms. Fifty-five percent of the mothers were secretors and 45% were non-secretors. Infant sex affected HMO levels depending on the maternal secretor status. Secretor mothers to boys had higher levels of FUT2-dependent OS and higher levels of disialyllacto-N-tetraose in the milk of mothers to girls, whereas non-secretor mothers to girls had higher levels of 3′-sialyllactose. In addition, the season at which the human milk samples were obtained affected the levels of some HMOs, resulting in significantly lower levels in the summer. Our findings provide novel information on the irregularity in the HMO profile among Israeli lactating women and identify several factors contributing to this variability.

C-reactive protein (CRP) is a well-established marker of inflammation in neonates. Recent studies have shown the potential of CRP velocity as an early indicator of infection disorders in children and adults. However, data on CRP dynamics in the neonatal population remain limited. Our objective was to assess the dynamics of CRP levels and determine their clinical relevance in newborns admitted to the nursery. This is a retrospective review of medical records of neonates ≥ 35 weeks of gestation with a birth weight of ≥ 2000 g, who underwent partial sepsis work-up with at least 2 consecutive CRP measurements within the first 48-h of life, between January and December 2020. CRP dynamics were analyzed using CRP velocity (CRPv, mg/L/h), calculated by dividing the interval between the first two consecutive CRP measurements by the corresponding interval time. A total of 212 neonates were included in the study. Neonates admitted to the neonatal intensive care unit (NICU) presented with higher levels of CRPv (p = 0.047), and were more likely to experience hypoglycemia (p = 0.023) and respiratory distress (p = 0.023). Lower CRPv levels were associated with elective cesarean surgery (p = 0.043). Among neonates with CRPv ≥ 2 mg/L/h, female infants exhibited even higher CRPv values (p = 0.018). Only two cases of blood culture-confirmed neonatal sepsis were identified, with CRPv values of 3.22 and 0.02 mg/L/h., Neither case required NICU admission. Regression analyses revealed that higher gestational age was significantly associated with elevated CRPv levels (p = 0.004) whereas hypothermia was linked to lower CRPv values (p = 0.031). In neonates, CRP dynamics generally corresponded to their overall clinical condition but were also influenced by various non-infectious factors, including GA, mode of delivery and gender. Additionally, neonatologists should consider the recent finding that neonatal hypothermia was associated with decreased CRP levels when assessing ill-appearing newborns with low CRP measurements.

Background: Neonatal pneumothorax is dependent on severity of symptoms and leak size. Treatment of Pneumothorax with Nitrogen washout is controversial. Objective: To compare outcomes of neonates treated for spontaneous pneumothorax (SP) compared with those managed expectantly. Methods: A retrospective review of medical records of neonates (≥34weeks) diagnosed with SP born between 2011 and 2021. Neonatal characteristics and outcomes were compared between neonates treated for SP with either targeted oxygen therapy (to stabilize saturation ≥93%) or nitrogen washout and those under expectant management. Results: Among neonates with respiratory distress and desaturation (n = 64), nitrogen washout reduced median time to resolution compared to targeted oxygen therapy (31 [12–67] vs 81 [31.8–123.5] hours, p = 0.012). Expectantly managed neonates with distress (n = 87) experienced delayed feeding initiation, while time to resolution and hospital stay were similar. Conclusion: Nitrogen washout is superior to targeted oxygen therapy in time to resolution in infants presenting with respiratory distress and desaturation.

The incidence of spontaneous intestinal perforation (SIP) increases up to 10% with decreasing gestational age (GA). We aimed to explore early biomarkers for predicting SIP in preterm infants. In this case–control study, neonates born at ≤34 weeks GA diagnosed with SIP were compared with GA and/or birth-weight-matched neonates diagnosed with necrotizing enterocolitis (NEC). Laboratory markers assessed prior and adjacent to the day of SIP or NEC diagnosis were evaluated. The cohort included 16 SIP and 16 matched NEC infants. Hyperlactatemia was less frequent in SIP than in NEC infants (12% vs. 50%, p = 0.02). The platelets count was lower in SIP than in NEC infants (p < 0.001). Glucose levels strongly correlated with lactate levels (p = 0.01) only in the NEC group. The odds of being diagnosed with SIP decreased as lactate levels increased (OR = 0.607, 95% CI: 0.377–0.978, p = 0.04). Our results suggest that a combination of laboratory markers, namely glucose and lactate, could help differentiate SIP from NEC at early stages so that, in the presence of an elevated blood glucose, an increase in blood lactate was associated with a decrease in the odds of being diagnosed with SIP.

Background: Human milk (HM) is the optimal nutrition for preterm infants, but supplementation is often required to meet their unique nutritional needs. Donor human milk (DHM) and preterm formula are commonly used alternatives, yet their impacts on bone metabolism and clinical outcomes remain incompletely defined. Objective: To compare the effects of exclusive mother’s own milk (MOM), MOM supplemented with DHM, and MOM supplemented with preterm formula on bone metabolism markers, growth milestones, and clinical outcomes in very preterm and very low birth weight (VLBW) infants. Methods: We conducted a retrospective review of medical records for infants born at <32 weeks’ gestation or <1500 g birth weight between January 2018 and June 2023. Feeding groups included exclusive MOM (N = 135), MOM + DHM (N = 74), and MOM + Formula (N = 54). Biochemical markers were assessed at baseline and on days 7, 14, and 28. Multivariate regression analyses evaluated predictors of growth and clinical outcomes. Results: Infants in the MOM group had significantly lower gestational age and birth weight, with higher rates of respiratory morbidity. Time to full enteral feeding and duration of parenteral nutrition were longer in the MOM group, but feeding regimen was not an independent predictor of these outcomes. By day 14, the MOM group had higher alkaline phosphatase levels and lower phosphorus levels compared to mix feeding groups, but these differences resolved by day 28. Calcium levels varied between groups but remained within normal ranges. Necrotizing Enterocolitis (NEC) incidence did not differ significantly across feeding regimens and was primarily associated with longer parenteral nutrition duration. Conclusions: Supplementation of MOM with either DHM or preterm formula supported adequate growth and bone metabolism without increasing NEC risk. Feeding regimen did not independently influence time to full enteral feeding or length of hospitalization, which were driven primarily by infant maturity and clinical status. Both DHM and preterm formula are viable supplements to MOM, ensuring nutritional adequacy without adverse bone health effects. Prospective studies are needed to evaluate long-term outcomes of these feeding strategies.

Demand for upper gastrointestinal contrast series (UGI) to investigate bilious vomiting (BV) has increased in recent years, mostly due to greater awareness of the need to rule out malrotation and midgut volvulus (MGV). We aimed to examine predictive value of clinical parameters in management of healthy neonates presenting with BV and re-assess the role of UGI in their management. A retrospective cohort study including medical, imaging and surgical data of neonates who underwent UGI due to BV. A total of 157 term neonates, eight neonates (5.1%) had confirmed surgical diagnosis of malrotation, five of them had malrotation with MGV, including two neonates who underwent extensive intestinal resection due to necrosis. Neonates with a combination of abnormal Plain radiograph and abdominal distention had 10 times higher odds of malrotation diagnosis, adjusting for age at first BV (p=0.017). Neonates with a combination of abnormal Plain radiograph, abdominal distention and abdominal tenderness had 25 times higher odds of MGV (p=0.002). This study reaffirms the role of UGI as the current main diagnostic tool for malrotation and MGV. Physical examination and Plain radiograph findings can help but cannot substitute UGI study.