Vegetarian and vegan diets have increased worldwide in the last decades, according to the knowledge that they might prevent coronary heart disease, cancer, and type 2 diabetes. Althought plant-based diets are at risk of nutritional deficiencies such as proteins, iron, vitamin D, calcium, iodine, omega-3, and vitamin B12, the available evidence shows that well planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients. A review of the scientific literature in this field was performed, focusing specifically on observational studies in humans, in order to investigate protective effects elicited by maternal diets enriched in plant-derived foods and possible unfavorable outcomes related to micronutrients deficiencies and their impact on fetal development. A design of pregestational nutrition intervention is required in order to avoid maternal undernutrition and consequent impaired fetal growth.

This study evaluated the impact of an exclusive human milk diet to nourish extremely low birth weight infants in the neonatal intensive care unit. This multicenter pre-post retrospective study included all inborn infants <1,000 g admitted to four Level IV neonatal intensive care units either before or after implementing a donor human milk policy. The feeding protocol was unchanged in both periods. Collected data included maternal/infant demographics, infant clinical data, and enteral intake as mother's own milk, donor milk, and formula. Two hundred one infants were enrolled. Infant growth and other clinical outcomes were similar in both groups. Exposure to mother's own milk at discharge was not different. Median time in oxygen and duration of mechanical ventilation were significantly higher among formula-fed infants (63 versus 192 hours [p=0.046] and 24 versus 60 hours [p=0.016], respectively). Our results add evidence supporting the safety of donor milk. This study also found an association between exposure to formula in preterm infants and the requirement for respiratory support, a finding that warrants further investigation.

Objective: To identify changes in macronutrient content of very preterm human milk associated with perinatal factors. Study design: Milk macronutrients were measured on weeks 1, 2, 4 and 8 with mid-infrared transmission spectrometers. Result: We assessed 625 samples (from 117 mothers and 130 very preterm infants). Average concentrations were: protein 1.3 ± 0.3 g/dl, carbohydrates 7.3 ± 0.6 g/dl, fat 3.7 ± 1.0 g/dl and energy 296.0 ± 41.0 kJ/dl (70.7 kcal/dl). Gestational age negatively correlated with protein (rho: −0.307, p < 0.001) and energy (r: −0.193, p = 0.003). Advanced maternal age, gestational age and intrauterine growth restriction were independently associated with milk protein content over the first 4 weeks (adjusted R²: 0.113, p = 0.002). Conclusion: These findings may help neonatologists identify patients fed Mother´s Own Milk who are at increased risk of poor postnatal growth.

Background Bronchopulmonary dysplasia (BPD) is a common cause of morbidity in preterm infants, leading to long-term respiratory complications and risk of neurodevelopmental impairment. Although it has a multifactorial etiology, local inflammation may play a major role. Objectives. We aimed to analyze the relationship between nasopharyngeal aspirate (NA) interleukin 6 (IL6) levels and clinical and imaging findings of BPD. Methods: Pilot study in preterm infants < 30 weeks. NA was collected at 7 days of life (DOL) and serial lung ultrasounds (LUS) were performed during admission. NA-IL6 levels were measured using an automated electrochemiluminescence immune-analyzer Cobas-e602 and an IL6 ELISA method. Results. Forty-two patients were studied. Infants with BPD had significantly lower gestational age and higher levels of NA-IL6 at DOL 7. Both methods showed good agreement: ICC = 0.937 (95%CI 0.908-0.957); p < 0.001) and Passing-Bablok Regression (R² = 0.961). LUS score (AUC = 0.83) and NA-IL6 (AUC = 0.81) at DOL 7 predicted BPD. The AUC of NA-IL6 as a stand-alone marker of BPD was 0.808 (95% CI 0.67 – 0.94); p = 0.002, with 24 pg/ml being the best cutoff with a sensitivity and specificity of 83.3%. A model including birth weight, LUS score at DOL7, NA-IL6 at DOL7, and days of mechanical ventilation predicted BPD with R² = 0.600 (p < 0.001). Conclusions. Point-of-care assessment of NA-IL6 is feasible and reliable compared with a reference method and can be useful in managing BPD. Predictive models of BPD in the first week of life, including clinical, biological, and imaging biomarkers must be tested in larger cohorts.