Background/Objectives: Cow’s milk allergy (CMA) manifests with various clinical syndromes and has a wide range of symptoms in infants. This study aims to investigate the prevalence, clinical presentation, and outcome of clinical types and subtypes of CMA diagnosed in children within the first 12 months of life. Methods: Children with a CMA diagnosis were included in this mixed retrospective and prospective cohort study and were followed up for four years. Data recorded included clinical manifestations, feeding modes, and outcomes. Follow-up included oral cow’s milk (CM) challenge and/or elimination—reintroduction of CM, provided there was parental consent. Also, skin prick test and serum CM-specific IgE were assessed when needed. Results: A total of 93 infants (age: 3 days to 24 months) diagnosed with CMA were included. Prevalence was 28% for IgE-mediated CMA and 72%, 49.5%, 18.3%, and 3.7% for non-IgE-mediated CMA and its subtypes, Allergic Proctocolitis (AP), Food Protein induced Enteropathy (FPE), and Food Protein Induced Enterocolitis Syndrome (FPIES), respectively. Main manifestations were gastrointestinal (74%), skin rash (31%), failure to thrive (11.8%), feeding aversion (15.1%), respiratory symptoms (5.4%), and irritability/restlessness (9.7%). Follow-up revealed a high rate of AP and FPE tolerance within the first year, while FPIES and IgE-mediated CMA achieved tolerance at an older age. Conclusions: Our study demonstrated the predominance of AP and increased incidence of gastrointestinal involvement. Outcome was good for AP and FPE but less favorable for FPIES and IgE-mediated CMA. Our results, combined with published data, could increase our understanding of CMA-associated syndromes in infants and contribute to the guidance of effective management.

Background/Objectives: Our aim was to assess the benefits and risks of fortified vs. unfortified human milk in preterm/low birth weight neonates and to incorporate the INSPECT-SR tool to enhance evidence appraisal. Methods: PubMed and Scopus were searched from inception to 30 November 2025, limited to human studies published in English. Randomized controlled trials in neonates ≤ 34 weeks’ gestation or ≤2500 g birth weight were included. Data extraction followed PRISMA guidelines. Risk of bias was assessed using Cochrane RoB 2, and trustworthiness using the INSPECT-SR tool. Random-effects models were used to pool mean differences (MDs) and odds ratios (ORs); heterogeneity was assessed with I². Outcomes included weight, length, and head circumference gain velocities, feeding intolerance, necrotizing enterocolitis, late-onset sepsis, chronic lung disease, time to full enteral feeding, length of stay, and mortality. Results: Fifteen randomized controlled trials involving 1079 neonates (546 receiving fortified human milk and 533 receiving unfortified human milk) were included in the analysis. Fortified human milk was associated with significantly greater weight gain (MD 2.74 [1.27–4.22] g/kg/d; I² = 95%), length gain (MD 0.08 [0.02–0.14] cm/week; I² = 90%), and head circumference gain (MD 0.06 [0.03–0.10] cm/week; I² = 87%). No significant differences were observed in feeding intolerance, necrotizing enterocolitis, late-onset sepsis, chronic lung disease, time to full enteral feeding, length of stay, or mortality. Subgroup analyses suggested that the publication era partially contributed to heterogeneity, although substantial residual heterogeneity remained. According to INSPECT-SR, two trials were judged as having no concerns, twelve as having some concerns, and one as having serious concerns regarding trustworthiness. Conclusions: Low-certainty evidence suggests that human milk fortification improves short-term anthropometric growth parameters in preterm and low birth weight infants without increasing major neonatal morbidities. However, the certainty of these findings is limited by substantial heterogeneity and concerns regarding study trustworthiness. Future adequately powered trials using contemporary fortification strategies and long-term follow-up are required to establish the clinical significance of these growth benefits.