Purpose: This study aims to achieve a better understanding of the trend of maternal milk macronutrient levels by analyzing protein, lipid, carbohydrate, and energy content of the breast milk and investigate the possible confounders of macronutrient content during the first 4 weeks of lactation to meet the specific needs of babies, guide optimum fortification of maternal milk. Patients and Methods: Breast milk from 39 mothers who had delivered preterm infants and 21 mothers of term infants were collected longitudinally for the first 4 weeks of lactation. Fresh milk samples were obtained on day 3, 7, 14, and 28 of lactation. The samples are analyzed using mid-infrared milk analyzer (MIRIS Human Milk Analyzer, HMA; Miris AB, Uppsala, Sweden). Results: Colostral milk protein concentrations of mothers of both preterm and term infants were significantly higher and the protein content of the samples decreased in time, according to the week of lactation during the study period. In contrast, fat, carbohydrate, and energy content were lowest in the colostral milk in both groups. When preterm and term milks were compared, fat and carbohydrate levels on 28th day and energy levels on 14th and 28th days were significantly higher in term milks, whereas no difference in protein contents were observed between the two groups on each time period. Mode of delivery was found to have statistically significant correlation with protein content of the milk. Conclusion: This longitudinal study revealed significant changes in analyzed macronutrient contents of mother's milk over the first 4 week period.

Say B, et al. Korean J Pediatr. 2017 Aug;60(8):248-253. https://doi.org/10.3345/kjp.2017.60.8.248

Background: Several retrospective studies have reported an increase in necrotizing enterocolitis (NEC) during the 48 hours following red blood cell (RBC) transfusion. Whether withholding enteral feeding during transfusion decreases the risk of transfusion-associated acute gut injury (TRAGI) in preterm infants is unclear. Study design and methods: In this pilot study, 112 preterm infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams were randomly assigned to withholding (NPO) or continuance of feeding (FED) during RBC transfusion. Primary outcome measure was development of NEC (stage ≥ 2) within 72 hours of a transfusion and the change in abdominal circumference. Results: One hundred fifty-four transfusion episodes (74 NPO and 80 FED) were analyzed. Demographic characteristics were found to be similar in both groups. There was no difference in rates of NEC (0 versus 3.4%; p = 0.49) between the NPO and FED groups. The incidence of feeding intolerance was higher in the FED group however it was statistically insignificant (1.9 versus 6.8%, p = 0.36). Abdominal circumference remained similar in both groups in all three consecutive days following transfusion (p > 0.05). Conclusion: This pilot study does not support withholding feedings during transfusion but is not adequately powered to test the hypothesis that NPO decreases NEC rates. Adequately powered well designed multicenter trials are still required.

The objective was to apply a population model to describe the time course and variability of serum creatinine (sCr) in (near)term neonates with moderate to severe encephalopathy during and after therapeutic hypothermia (TH). The data consisted of sCr observations up to 10 days of postnatal age in neonates who underwent TH during the first 3 days after birth. Available covariates were birth weight (BWT), gestational age (GA), survival, and acute kidney injury (AKI). A previously published population model of sCr kinetics in neonates served as the base model. This model predicted not only sCr but also the glomerular filtration rate normalized by its value at birth (GFR/GFR₀). The model was used to compare the TH neonates with a reference full term non-asphyxiated population of neonates. The estimates of the model parameters had good precision and showed high between subject variability. AKI influenced most of the estimated parameters denoting a strong impact on sCr kinetics and GFR. BWT and GA were not significant covariates. TH transiently increased $$\mathrm{sCr}$$sCr in TH neonates over the first days compared to the reference group. Asphyxia impacted not only GFR, but also the $$\mathrm{sCr}$$sCr synthesis rate. We also observed that AKI neonates exhibit a delayed onset of postnatal GFR increase and have a higher $$\mathrm{sCr}$$sCr synthesis rate compared to no-AKI patients. Our findings show that the use of $$\mathrm{sCr}$$sCr as marker of renal function in asphyxiated neonates treated with TH to guide dose selection for renally cleared drugs is challenging, while we captured the postnatal sCr patterns in this specific population. Graphical Abstract

Overweight and obesity are global issues, especially among women of childbearing age, linked to adverse maternal and neonatal outcomes. These risks vary by age, race, and ethnicity, with increasing rates among immigrant and minority women. This study compares overweight and obesity rates, pregnancy weight gain, and neonatal outcomes in Turkish and Syrian immigrant/refugee women. In this retrospective study, at Buca Seyfi Demirsoy Hospital in Izmir, Turkey a total of 1353 mother-infant pairs were checked for eligibility. Of the entire cohort of 1353 mother-infant pairs, 323 pairs with complete medical records were included. The primary outcome was rate of pregestational obesity or overweight as secondary outcomes were weight gain during pregnancy and adherence to guidelines, neonatal outcomes according to different BMI categories and possible impact of maternal weight gain on neonatal morbidities in two different ethic populations. Of the 323 mother-infant pairs, overweight/obese mothers had higher birth weights and cesarean-section rates. Syrian mothers were more likely to gain less weight than recommended. Neonatal outcomes, such as hospitalization and SGA/LGA birth rates, were similar across groups, with varying compliance to weight gain guidelines. Pre-pregnancy BMI and gestational weight gain significantly affect some of the neonatal outcomes. High obesity rates and ethnic disparities highlight the need for culturally tailored prenatal care to improve maternal and neonatal health, especially in immigrant populations. Further research with larger, diverse cohorts is needed.

Objective Preterm infants have high zinc (Zn) requirements and are generally believed to be in a negative Zn balance in the early period of life. In this study, we aimed to investigate the effect of high-dose Zn supplementation in very low birth weight (VLBW: infants with birth weight < 1.5 kg) infants on feeding intolerance and development of mortality and/or morbidities including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). Study Design This is a prospective randomized trial. VLBW preterm infants with gestational age of <32 weeks were randomly allocated on the seventh day of life to receive extra amount of supplemental Zn along with the enteral feedings (9 + 3 mg), besides regular low-dose supplementation (3 mg), from enrollment until discharge. Outcome measures were feeding intolerance, NEC (stage ≥ 2), LOS, and mortality. Results A total of 195 infants (97 from study group and 98 from control group) were analyzed. A total of 46 (47.4%) infants in the study group and 64 (65.3%) infants in the control group ended up with feeding intolerance (p = 0.012). NEC was observed in 11 infants (11.2%) in the control group and only 1 infant (1%) in the study group (p = 0.003). There was a negative correlation between high-dose Zn supplementation and number of culture-proven LOS episodes (p = 0.041). This significance was also present for clinical sepsis, being higher in the control group (p = 0.029). No relationship between high-dose Zn supplementation and mortality and other morbidities (hemodynamically significant patent ductus arteriosus, bronchopulmonary dysplasia, retinopathy of prematurity, and severe intraventricular hemorrhage) was observed. Conclusion Zn supplementation for VLBW infants is found to be effective to decrease feeding intolerance, NEC, and LOS episodes in this vulnerable population. Current data support the supplementation of VLBW infants with higher than regular dose of Zn. Key Points