Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The objective of this study was to evaluate growth velocities and incidence of extrauterine growth restriction in infants ≤ 1250 grams (g) birth weight (BW) receiving an exclusive human milk-based diet with early and rapid advancement of fortification using a donor human milk derived fortifier.

Background: Early parenteral nutrition (PN) provides essential macro- and micronutrients for extremely low birth weight (ELBW) infants <1000 g. Fr

Objective: To identify maternal and neonatal risk factors associated with progression to surgery or death after diagnosis of NEC. Study design: Forty-seven demographic and clinical factors were evaluated across 216 validated cases of NEC occurring between 2010–2020. Nutrition at NEC onset was evaluated in 149 cases. The binary outcome of surgical NEC (progressing to surgery or death) vs. medical NEC (resolved with antibiotic/bowel rest) was compared across variables. Results: Elevated CRP, rapidly decreasing platelet counts, inotropic medication, intubation, and positive blood cultures within 24 h of diagnosis were associated with progression to surgery/death. Infants with surgical NEC had higher abdominal circumferences at birth. Maternal milk intake and receipt of human milk fortifiers were associated with medical NEC, and infants receiving fortified, maternal milk showed the lowest progression to surgery/death. Conclusion: The index of suspicion should be heightened for surgical NEC when these risk factors are present.

Human milk, the best enteral selection for a preterm infant, becomes altered during freezing and soluble free fatty acid is generated over time. Free fatty acids may form complexes, such as the oleic acid-bound protein called HAMLET (human α-lactalbumin made lethal to tumor cells). We determined the in vitro biological activity of preterm human milk protein-oleic complexes (HAMLET-like complexes) and tested the hypothesis that laboratory-synthesized HAMLET exhibits cytotoxicity in human immature epithelial intestinal cell culture. Thirty-four milk samples from 15 mothers of hospitalized preterm infants were donated over time. Milk fractions were tested repeatedly for FHs 74 Int and HIEC-6 fetal cell cytotoxicity, using a sensitive viability assay. Protein and fatty acid identities were confirmed by Western blot, high performance liquid chromatography, and mass spectrometry. Cytotoxicity of intestinal cells exposed to milk increased respective to milk storage time (p < 0.001) and was associated with free oleic acid (p = 0.009). Synthesized HAMLET was cytotoxic in cultures of both lines. Preterm milk samples killed most cells in culture after an average 54 days in frozen storage (95% C.I. 34–72 days). After prolonged storage time, preterm milk and HAMLET showed a degree of cytotoxicity to immature intestinal cells in culture.

Background: Necrotizing enterocolitis (NEC) remains a highly morbid disease for preterm infants. The use of adjunct abdominal ultrasonography improves the evaluation of early or uncertain cases of NEC. No institutions have reported implementing a standardized adjunct abdominal ultrasound guideline and universally adopting adjunct abdominal ultrasound in routine neonatal practice for the evaluation of NEC. Objective: To determine if a standardized, adjunct abdominal ultrasound guideline for diagnosing NEC is feasible and beneficial for the routine detection of pathologic abdominal findings in NEC. Materials and methods: This retrospective study was conducted in an 82-bed level IV academic neonatal intensive care unit from February 2023-April 2024. Unit guidelines were updated in February 2023 to recommend the addition of an adjunct abdominal ultrasound to evaluate NEC universally at the time of initial evaluation. Imaging data was abstracted from a post-implementation observation period of 15 months. Implementation feasibility was assessed. Sonographic findings consistent with NEC were described after implementing standardized sonography protocols. Results: Adjunct abdominal ultrasound was performed in 22 of 23 cases (96%) of NEC following guideline implementation. Twenty ultrasounds (90%) had at least one finding suggestive of NEC, and 12 (55%) had multiple findings suggestive of NEC. Seven ultrasounds (32%) showed findings of NEC in cases with unremarkable initial abdominal radiographs. Two NEC cases had radiographic findings without abdominal ultrasound findings. The sensitivity of abdominal ultrasound for NEC was 0.91. In 59% of cases, abdominal ultrasound findings resulted in a higher modified Bell’s stage when compared to initial abdominal radiograph findings. Conclusion: Implementing a standardized adjunct abdominal ultrasound guideline to assist with the initial diagnostic evaluation of NEC is feasible and may aid in diagnosis of NEC. Graphical