Background: Prematurity significantly impacts neonatal health worldwide, necessitating effective interventions to improve outcomes for these vulnerable infants. While breastfeeding has emerged as a cornerstone of preterm care, its precise impact on neurodevelopment remains a subject of ongoing inquiry and debate. This systematic review aims to investigate the existing evidence in this area.Methods: On December 17, 2023, online databases including PubMed, The Cochrane Library, Embase, Web of Science, CNKI, VIP, CBM, and Wan Fang Data were searched. Comparisons were classified into several categories: never breastfeeding (Never-BF) versus exclusive breastfeeding, Never-BF versus any breastfeeding (Any-BF), predominant preterm formula (Pre-PTF) versus predominant breastfeeding (Pre-BF), and Pre-PTF versus predominant donor breast milk (Pre-DBM) groups. Randomized controlled trials and observational studies were analyzed separately through meta-analyses. Each study’s risk of bias was assessed, and the GRADE system was utilized to evaluate the certainty of the findings.Results: Sixteen studies met the inclusion criteria, comprising one RCT and 15 cohort studies. The key findings indicated that infants in the Any-BF groups demonstrated superior long-term cognitive scores compared to those in the Never-BF groups, particularly evident in infants assessed before 18 months in the Pre-BF groups versus Pre-PTF groups. A reduced risk of neurodevelopmental impairment was also observed in preterm infants in the Any-BF groups. Evidence regarding the effect of breastfeeding on motor development was inconclusive, except for potential motor improvement in extremely low birth weight infants in the Any-BF groups. Neither exclusive breastfeeding nor pre-DBM exhibited clear superiority over Pre-PTF in terms of neurodevelopmental outcomes for preterm infants. Caution is warranted due to potential publication bias impacting the assessment of breastfeeding’s impact on motor skills.Conclusion: Our systematic review supports current recommendations for breastfeeding in preterm infants, emphasizing its positive effects on cognitive abilities and reduced risk of neurodevelopmental disorders. Further studies are needed to clarify if DHM provides neurodevelopmental benefits comparable to maternal milk, as current evidence does not sufficiently address this question. Additionally, future investigations should prioritize refining our understanding of the influence of breastfeeding on motor development in this vulnerable population.Systematic review registration: PROSPERO, identifier CRD42023492274, Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492274.

Introduction Necrotising enterocolitis (NEC) of the intestine of preterm infants leads to the risk of abdominal surgery, short bowel syndrome, neurodevelopmental disorders and death. Although the risks of NEC and its complications have been recognised in many countries, few countries have established NEC-specific registries to continuously monitor its aetiology and prognosis. In China, the understanding of risk factors and prognosis of NEC is incomplete, characterised by a lack of evidence from prospective and multicentre studies. Therefore, we designed a multicentre, prospective, open observational cohort study with the aim of investigating the risk factors and prognosis of NEC in a real-world setting in Shenzhen, Guangdong Province, by constructing an online registry of children with NEC and a bank of biospecimens. Methods This is a prospective, multicentre, open observational cohort study. From June 2024 to June 2028, more than 600 patients with NEC from 15 tertiary hospitals in Shenzhen, Guangdong Province, will be enrolled in the study. By constructing an online registry for NEC, clinical data will be collected during the prenatal and hospitalisation periods. Prospectively, biospecimens will be collected during the period of suspected NEC, at the time of confirmed NEC, and at the time of confirmed severe NEC, and filed in the online registry system. Follow-up data will include postdischarge healthcare needs, growth patterns measures, eye or vision examinations, cranial MRI findings, brainstem auditory evoked potentials or automated auditory brainstem responses, and the Chinese Griffith Developmental Scale at corrected age 18–24 months. Follow-up results were likewise recorded in an online registry system. Hospitalisation outcomes, including severe NEC, somatic growth and survival status, will be collected at discharge. Follow-up outcomes will include loss to visit, survival status, somatic growth measures and severe neurodevelopmental deficits at corrected age 18–24 months. This study will enhance our overall understanding of the risk factors and outcomes of NEC, ultimately helping to reduce the incidence of neonatal NEC and its poor prognosis. Ethics and dissemination Our programme has received approval from the Ethics Committee for Scientific Research Projects of the Longgang District Maternity & Child Healthcare Hospital in Shenzhen City (ethics approval number: LGFYKYXMLL-2024-47-01). We anticipate presenting our findings at various national conferences and submitting them to peer-reviewed paediatrics journals. Trial registration number ChiCTR2400085043.

Background: Neonatal Acute Respiratory Distress Syndrome (NARDS) is a critical contributor to neonatal morbidity and mortality, with a global health burden that varies significantly by region. The Montreux definition provides a unified diagnostic framework; however, a significant clinical paradox exists. A prospective cohort in China reported a NARDS mortality rate of 12.6%, which is notably lower than the 17%–24% reported in a large-scale international prospective study. The underlying reasons for this discrepancy remain to be elucidated, whether due to differences in etiology, clinical practice, or patient demographics. Methods: The Shenzhen Neonatal ARDS Cohort Study (SZ-NARDS) is a prospective, multicenter observational cohort study spanning from 2025–2028, designed to address this knowledge gap. We will enroll more than 1,000 neonates who meet the Montreux criteria across nine tertiary neonatal intensive care units (NICUs) in Shenzhen, China. Longitudinal data collection includes granular clinical parameters, respiratory support metrics, and multi-modal biospecimens for deep phenotyping and multi-omics profiling. Survivors will undergo rigorous follow-up until 36 months' corrected age, with standardized neurodevelopmental, pulmonary, and growth assessments. Results: The primary objective of this study is to characterize the epidemiology of NARDS in this regional population and to test the following hypotheses: (1) The true incidence, etiology, and mortality rates of NARDS in Shenzhen will differ from existing international and Chinese cohorts, and these differences can be systematically explained by specific clinical and demographic factors. A multi-modal predictive model that integrates early clinical variables with multi-omics biomarkers has the potential to accurately identify neonates at high risk for severe NARDS [oxygenation index (OI) ≥ 16] and long-term adverse outcomes [Area Under the Receiver Operating Characteristic Curve (AUROC) > 0.85]. Conclusions: The SZ-NARDS cohort is uniquely positioned to resolve a major clinical contradiction in NARDS epidemiology. By integrating deep phenotyping with a longitudinal biobank and advanced machine learning algorithms, this initiative will generate a comprehensive dataset. This dataset will serve to refine existing prognostic models, identify regional disparities in disease biology, and inform the development of precision medicine interventions for this vulnerable population. Clinical Trial Registration: Chinese Clinical Trial Registry, identifier ChiCTR2400093854.