Background: Data regarding the incidence and mortality of necrotizing enterocolitis trends are scarce in the literature. Recently, some preventive strategies have been confirmed (probiotics) or increased (breastfeeding rate). This study aims to describe the trends of necrotizing enterocolitis incidence, treatment, and mortality over the last decade in Spain. Methods: Multicenter cohort study with data from the Spanish Neonatal Network–SEN1500 database. The study period comprised from January 2005 to December 2017. Preterm infants <32 weeks of gestational age at birth without major congenital malformations were included for analysis. The main study outcomes were necrotizing enterocolitis incidence, co-morbidity (bronchopulmonary dysplasia, late-onset sepsis, cystic periventricular leukomalacia, retinopathy of prematurity, acute kidney injury), mortality, and surgical/non-surgical treatment. Results: Among the 25,821 included infants, NEC incidence was 8.8% during the whole study period and remained stable when comparing 4-year subperiods. However, more cases were surgically treated (from 48.8% in 2005–2008 to 70.2% in 2015–2017, p < 0.001). Mortality improved from 36.7% in the 2005–2008 to 26.6% in 2015–2017 (p < 0.001). Breastfeeding rates improved over the studied years (24.3% to 40.5%, p < 0.001), while gestational age remained invariable (28.5 weeks, p = 0.20). Prophylactic probiotics were implemented during the study period in some units, reaching 18.6% of the patients in 2015–2017. Conclusions: The incidence of necrotizing enterocolitis remained stable despite the improvement regarding protective factors frequency. Surgical treatment became more frequent over the study period, whereas mortality decreased.

Background: Postnatal growth restriction is very common among preterm infants. Growth restriction might be associated with neurodevelopment impairment. The definition of postnatal growth restriction varies among studies. It has often been based on statistical parameters, but we lack biological data to support this definition. Objectives: The aim here was to study the association between neurodevelopment and postnatal growth restriction defined applying 2 different strategies. Methods: Bayley Scales of Infant Development-II was performed at 2 years corrected age in 168 preterm infants. Postnatal growth restriction was defined as a weight z-score at 36 weeks <–1.5 or treated as a continuous variable (fall in weight z-scores from birth to 36 weeks postmenstrual age). Results: Weight z-scores fell in almost all patients (98.8%), and 44.1% had z-scores <–1.5 at 36 weeks. After adjusting for gestational age and small for gestational age at birth, every 1-point fall in weight z-score was associated with a 5.6 point (95% CI 1.7 to 9.4) decrease in the Mental Developmental Index. A weight z-score <–1.5 at 36 weeks was not associated with a worse mental or psychomotor result. Conclusion: A fall in the weight z-score from birth to 36 weeks is a more rational definition of postnatal growth restriction, and it could predict neurodevelopment.

Necrotizing enterocolitis (NEC) is a devastating disease of premature infants with high mortality rate, indicating the need for precision treatment. NEC is characterized by intestinal inflammation and ischemia, as well derangements in intestinal microcirculation. Remote ischemic conditioning (RIC) has emerged as a promising tool in protecting distant organs against ischemia-induced damage. However, the effectiveness of RIC against NEC is unknown. To address this gap, we aimed to determine the efficacy and mechanism of action of RIC in experimental NEC. NEC was induced in mouse pups between postnatal day (P) 5 and 9. RIC was applied through intermittent occlusion of hind limb blood flow. RIC, when administered in the early stages of disease progression, decreases intestinal injury and prolongs survival. The mechanism of action of RIC involves increasing intestinal perfusion through vasodilation mediated by nitric oxide and hydrogen sulfide. RIC is a viable and non-invasive treatment strategy for NEC.

Background:  Epidemiologic and experimental studies suggest that higher intake of dairy products could be associated with lower risk of hypertension and obesity. Differences in nutrient composition of distinct dairy products suggest that their effect on these outcomes might be heterogeneous. However, little experimental research has examined the potentially different effects of low‐ and whole‐fat dairy products on blood pressure (BP) and weight change. The present study aimed to assess whether supplementing diets with low‐ or whole‐fat dairy products would differentially affect BP levels and weight.Methods:  A randomised crossover trial in 45 normotensive volunteers (18–24 years old, 49% female) was conducted. Participants alternatively received 3.5 servings/day of whole‐fat or low‐fat dairy products (milk and yogurt) in addition to their usual diet during two 8‐week periods, with a 4‐week washout period between both interventions. Weight and BP were measured at the beginning and end of each intervention.Results:  Whole‐fat dairy supplementation significantly increased systolic BP [2.1 mmHg, 95% confidence interval (CI) = 0.1–4.0, P = 0.04] and weight (1.0 kg, 95% CI = 0.5–1.5, P = 0.0002), but not diastolic BP (P = 0.34). Weight and BP did not change significantly after the low‐fat dairy intervention (P > 0.10). There were no significant differences in the effect of low‐fat or whole‐fat dairy products on BP (P > 0.60), but whole‐fat dairy increased weight significantly compared to low‐fat dairy (1.2 kg, 95% CI = 0.5–1.8, P = 0.0007).Conclusions:  In a young nonhypertensive population, dietary supplementation with whole‐fat dairy products, compared to low‐fat dairy, was associated with weight gain. No differential effects were observed for levels of BP.

Objective: To systematically review and meta-analyse the rate of SARS-CoV-2 genome identification and the presence of SARS-CoV-2 antibodies in breastmilk of mothers with COVID-19. Design: A systematic review of studies published between January 2019 and October 2020 without study design or language restrictions. Setting: Data sourced from Ovid Embase Classic+Embase, PubMed, Web of Science, Scopus, relevant bibliographies and the John Hopkins University COVID-19 database. Patients: Mothers with confirmed COVID-19 and breastmilk tested for SARS-CoV-2 by RT-PCR or for anti-SARS-CoV-2 antibodies. Main outcome measures: Presence of SARS-CoV-2 genome and antibodies in breastmilk. Results: We included 50 articles. Twelve out of 183 women from 48 studies were positive for SARS-CoV-2 genome in their breastmilk (pooled proportion 5% (95% CI 2% to 15%; I²=48%)). Six infants (50%) of these 12 mothers tested positive for SARS-CoV-2, with one requiring respiratory support. Sixty-one out of 89 women from 10 studies had anti-SARS-CoV-2 antibody in their breastmilk (pooled proportion 83% (95% CI 32% to 98%; I²=88%)). The predominant antibody detected was IgA. Conclusions: SARS-CoV-2 genome presence in breastmilk is uncommon and is associated with mild symptoms in infants. Anti-SARS-CoV-2 antibodies may be a more common finding. Considering the low proportion of SARS-CoV-2 genome detected in breastmilk and its lower virulence, mothers with COVID-19 should be supported to breastfeed.