Gandhi is universally admired and respected across the world as one the most inspirational political figures campaigning for independence and civil rights in both South Africa and India; lands that were colonised and ‘stolen from’ for centuries by British rule.By chance I am in India today, on Gandhi’s birthday (Jayanti). I’ve been privileged to present at workshops and give lectures at conferences and NICUs, and been invited to join ward rounds and discuss various aspects of neonatal nutrition. A common challenge is ensuring adequate growth, sufficient electrolyte intakes and maintaining serum concentrations especially those <1000g. Promotion, and use of, Mother’s Own Milk (MOM) is universal across India, and many NICUs in privately run facilities also now operate their own donated human milk banks. Some NICUs are also being approached by mother’s experiencing baby loss, to offer their milk in memory of their baby who died (Lactation after Loss), the topic of one of my workshops.The Salt March of 1930, led by Mahatma Gandhi, is one of the most transformative events in India’s struggle for independence. Gandhi and followers undertook a 240-mile march to the Gujarat coast on the Arabian/Indian sea. Salt is an essential nutrient, especially in hot climates where losses through sweat are high. It had been traded for centuries before the British imposed the Salt Laws, which made it illegal to collect or sell salt which was heavily taxed and controlled. Gandhi recognised that taxing an essential biological nutrient was an extreme act of colonial oppression affecting every Indian. Raising this issue was a masterstroke of political strategy that crossed societal boundaries. Salt taxes disproportionately penalised the poorest and highlighted the moral bankruptcy of colonial rule.Salt & evolutionEverything in biology is explained by evolution. Hundreds of millions of years ago, life originated in the primordial oceans and the first single celled and early multicellular organisms developed in a highly saline environment, from which all cellular processes depended on the surrounding sea water. When animals migrated out of the sea, they couldn’t leave the ocean behind and developed complex renal and hormonal metabolism to enclose that ancient ocean.Salt is essential for human survival, regulates fluid balance, nerve transmission and muscle function. It is one of the most critical nutrients for preterm infants, who are born prior to the 3rd trimester when sodium is accumulated as ‘osmotically inactive’ sodium reserves in bone, skin and other tissues. This may help compensate for the relatively low [Na] in MOM. However, most people on the NICU are far more interested in ‘sexier’ nutrients like protein, DHA, zinc etc. and salt needs are rather under-appreciated.Preterm infants have a high requirements for sodium due to several factors including:limited body storeshigh growth ratesrenal tubular immaturitylow sodium concentration in human milkSodium potassium pumps in every cell maintain the electrical charge across cell membranes enabling nerve transmission and muscle function, and help maintain osmotic balance and blood volume. Term-born infants only receive/need around 1-2mmol/kg/d sodium in MOM, but preterm infants require much higher intakes because of rapid growth and urinary losses. Fractional excretion of sodium (FeNa) is typically high.Salt concentration of early milk and colostrum is higher, but most preterm infants only receive small volumes. There have also been concerns that adding too much sodium to PN in the first 1-2 days may provoke fluid retention and worsen later BPD. High [Na] in the first 2-3 days are also common and may represent excess trans-epidermal water loss, prompting many to believe that additional sodium is not needed.Serum sodium - common mistakesBlood/serum [Na] measures the concentration of sodium and not the total mass, as most sodium is extravascular in the interstitial tissues and also bone. A normal serum sodium can mask massive sodium depletion. Once the baby is total body sodium deficient it can be very hard ever to catch up, and all of us have witnessed infants where we keep prescribing i.v. corrections to no avail. When we updated the ESPGHAN guidelines in 2022 we noted that many very preterm babies need more than than 3-5mmol/kg/d previously recommended, and suggested intakes up to 8mmol/kg (or occasionally higher) might be needed.Clinical practiceBecause sodium is vital for both nerve function and growth, it makes sense to provide recommended intakes in the first few days rather than wait for [Na] to drop. It’s analogous to meeting macronutrient intakes with fortifier or formula before waiting for the baby to experience growth faltering. ‘Prophylaxis’ is the key.Do higher salt intakes improve outcomes?Whilst there are no well powered large RCTs, the accumulating evidence suggest sodium intakes are important for growth and perhaps brain development. There is little point giving optimal intakes of protein and calories, if there isn’t sufficient sodium to accrete into lean tissue.Conclusions and recommendations from ESPGHAN are summarised below.

Fabian J. S. van der Velden and Prakash Kannan Loganathan from James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK, review the article "Djordjevich CJ, Magers J, Cantey JB, Prusakov P, Sánchez PJ, Duration of Antibiotic Therapy for Gram-Negative Bloodstream Infections in the Neonatal Intensive Care Unit, The Journal of Pediatrics (2026), doi: https://doi.org/10.1016/j.jpeds.2026.114993. PMID: 41554433" for for ebneo.org.READ HERE!ACTA PAEDIATRICA COMMENTARY:Acta Paediatrica - 2026 - Velden - EBNEO Commentary Duration of Antibiotic Therapy for Gram‐Negative Bloodstream.pdf"Gram-negative bloodstream infections (GNBSIs) are an important cause of morbidity and mortality in neonates(1, 2). Recognition and early instigation of appropriate antibiotic treatment is paramount to improve outcomes. The optimal duration of treatment for GNBSI remains uncertain, and prolonged courses may not be necessary for all infants. The aim should be to use the shortest effective course, balancing clinical recovery with the risks of antimicrobial resistance and the potential longer-term harms of unnecessary antibiotic exposure. Prolonged courses of antibiotics have been associated with increased risk of necrotising enterocolitis in premature neonates(3), an increased risk for allergic disease, and inflammatory bowel disease later in life(4). In parallel, antimicrobial resistance remains a growing concern, with reported resistance among neonatal E. coli isolates reaching 50–75% for amoxicillin, 15–30% for gentamicin, and 46% for cefotaxime(1, 5). Although defined as ≤8 versus ≥9 days, the effective comparison was approximately 7 versus 14 days (short: median 7 days, 67% at 7 days; long: median 14 days; only 9 and 1 infant at the 8- and 9-day boundary). Within this contrast outcomes were broadly similar; treatment failure (same-organism recurrence within 14 days; 5% vs 0%) and subsequent multidrug-resistant gram-negative (MDRO) infection occurred only in the longer-course group. The design cannot recover a dose-response or inform intermediate durations. An important limitation is confounding by indication. Infants in the longer-course group appeared clinically more complex, with higher central venous catheter use (68% vs 38%), all cases with multiple positive blood cultures (19% vs 0%), and greater exposure to broader-spectrum monotherapy such as cefepime or piperacillin-tazobactam (49% vs 10%), whereas gentamicin monotherapy was more common in the shorter-course group (36% vs 11%). These findings suggest that clinicians were already tailoring both antibiotic duration and spectrum according to perceived illness severity or complexity. Therefore, the higher MDRO rate in the longer-course group may reflect broader-spectrum exposure and underlying case mix rather than duration alone. This is reinforced by the MDRO definition itself—any-site detection within 90 days—with events occurring 10–82 days later and predominantly new E. coli ESBL isolates that are plausibly independent acquisitions.Blood culture volume, sampling technique, and repeat-culture practice were not reported, and the methods do not explain how metastatic foci (bone, abscess) were excluded. Because lumbar puncture was not always performed at presentation, post-antibiotic or traumatic CSF sampling may have under-recognised meningitis. The study is underpowered, with no multivariable or propensity adjustment and no confidence intervals. Survivorship bias is also a concern: the 27 of 67 excluded infants who died before day 7 could not experience the outcome, and reaching ≥9 days itself required survival, favouring the longer-duration group on mortality. Importantly, the 7 NICUs sit within only 2 healthcare systems under shared stewardship, so this reflects closer to two practice cultures than seven independent centres; gentamicin monotherapy was viable only because local E. coli and Klebsiella susceptibility was 92–95%, against the 15–30% resistance cited in the literature, and centres with higher resistance could replicate neither strategy—narrowing external validity. Taken together, these data support a hypothesis-generating comparison of approximately 7 versus 14 days in a selected, lower-acuity, vasopressor-excluded population managed within two health systems. Given the small sample, methodological limitations, and risk of bias, the findings justify a prospective trial rather than a change in practice, consistent with the authors’ own conclusion.Artificial intelligence disclosure: ChatGPT (OpenAI; GPT-5.4 Thinking) was used to support drafting, language editing, and improvement of clarity in this commentary. The authors independently reviewed, critically appraised, revised, and approved the final content, and take full responsibility for the accuracy and interpretation of the work."

Everybody says conferences are the place to network. But how do you network when you are just starting out? Or when you rarely get to go to conferences? Or when you are coming back after a break, and everyone seems to know each other already?At 99nicu, we are clinicians and scientists at almost every stage of our careers. And, sad to say, we know that feeling quite well. Many of us do more than clinical work: research, teaching, building communities like this one. Yet most of us have stood alone with a coffee, wondering who to talk to. Awkward? Yes.We also know that “networking” can feel like a transaction. Waiting around the corner for a chance to talk to that one person. Asking questions in front of a poster just to start a conversation. Or holding back, because you feel you don’t have much to offer yet. That’s not what we are here for. We are here for real connections, where nobody needs a reason to say hello.Why a treasure hunt?We wanted to bring something a little unusual to a very scientific conference: a treasure hunt. Yes, just like the ones from childhood birthday parties or beloved team-building days.Why? Because we are used to fast social media. One line, one hashtag, a few likes and a comment, and we get our small dopamine boost. Then we move on to the next shiny thing. But what if we tried to engage here and now instead?At a conference like CEPAS, nobody can be everywhere or meet everyone. So we invite you to slow down, look around, and bring us what caught your attention.Take 3 pictures:📸 A conclusion slide from a lecture or session (when allowed). Why did it catch your eye? Will it change your practice? Or the way you look at your own research?📸 A poster (when allowed). Do you see a chance to work together? Is it close to your own topic, or something completely different?📸 A selfie with someone you’ve just met. Who are they? What stage of their career are they in? Do you share research interests? Or are they first-timers too, just looking for a selfie partner for the Treasure Hunt?You don’t have to post your pictures anywhere (unless you want to!). Just bring them to the 99nicu booth in the Meet & Connect Zone, show them to us and tell us about your experience. The first 50 people will get a 10% discount voucher for the upcoming 99nicu conference and precious 99nicu pin (they are awesome, we are very proud of them).While you’re there, charge your phone, try our pen-and-paper puzzles, or just sit down and talk with us.We’ll also introduce the Treasure Hunt in a short session on Thursday 29 October, 10:10–10:25.Less scrolling, more talking. See you in Lyon!--Kat from 99nicu

1st NeoMeMo – Neonatology Conference: Mediterranean and More28–29 November 2026 | Thessaloniki, GreeceThe Hellenic Neonatal Society is pleased to invite you to the 1st Neonatology Conference: Mediterranean and More (1st NeoMeMo), taking place on 28–29 November 2026 in Thessaloniki, Greece.The meeting will bring together neonatologists, pediatricians, nurses, researchers, and other healthcare professionals involved in newborn care from the Mediterranean region and beyond.The scientific programme will focus on current and emerging topics in neonatal medicine, with lectures, clinical discussions, and opportunities for scientific exchange and networking.The conference is organized by the Hellenic Neonatal Society and is held under the auspices of the Union of European Neonatal and Perinatal Societies (UENPS).Venue: Thessaloniki, GreeceDates: 28–29 November 2026Registration and further information:https://mk-premium.com/event/first-neonatology-conference-mediterranean-more/

The colour of breastmilk is rarely a uniform, static white and changes during the day, stage of lactation and maternal diet. Colostrum is often yellow or orange due to high concentrations of beta-carotene. At the start of a pump or feed, foremilk appears ‘thin’, almost watery, sometimes with a blue/translucent tint due to lower fat content whereas hind milk is more typically creamy white or yellow. Maternal diet impacts colour variations. Eating large amounts of foods rich in carotene—such as carrots, pumpkins, or sweet potatoes—can deepen the yellow tint of mature milk. Consuming high amounts of green vegetables (spinach or kale), seaweed, or supplements containing spirulina or iron can give breastmilk a green hue.I’ve been lucky to meet neonatal doctors, nurses and parents in multiple countries around the world and was contacted for advice via a neonatal colleague when the mother developed pink milk, and I then helped write up the case. Cracked nipples might lend breast milk an orange/brown colour but what foods might lead to pink milk? In Brazil. I decided I should take a look.Thanks for the invitation. This has recently been published and I include extracts of the paper here, with some minor space-saving edits."Leite materno rosa: implicações clínicas e relato de caso". Autores: Fernandes PS, Embleton N, Gonçalves AB. Referência: Rev Pediatria SOPERJ 2026;26(4): e20260410.Pink Breast Milk: Clinical Implications and Case Report.The composition of breast milk is complex and dynamic. It provides essential nutrients to the infant, including proteins, fats, lactose, vitamins, and minerals, as well as bioactive substances with antimicrobial, immunological, and anti-inflammatory properties. This composition varies throughout lactation, across different times of the day, and even during a single feeding session. Although such variations affect milk density and appearance, they typically do not cause colour changes as striking as those observed in pink breast milk [1,2]. Alterations in breast milk coloration are occasionally observed in clinical practice and may reflect physiological, dietary, traumatic, or infectious causes. Among these alterations, the occurrence of pink-tinted breast milk, stands out.CASE REPORTFemale newborn, born at term, AGA. At the first postnatal check-up, the infant showed significant weight loss (11.5%), and breastfeeding technique guidance was provided. The parents are healthy, no significant pregnancy complications, baby well other than poor weight gain.At 9 days of life, the mother required manual intrauterine aspiration due to chorioamnionitis. She was hospitalized for three days and received intravenous antibiotic therapy (gentamicin, metronidazole, and ciprofloxacin), followed by oral amoxicillin-clavulanate. During hospitalization and after discharge, breastfeeding was maintained; however, the infant continued to have poor weight gain. Speech therapy assessment didn’t show ankyloglossia (tongue tie) and due to poor weight gain, infant formula was introduced.At 33 days of life, the mother had noticed pink-stained towels and pink milk at the bottom of the bottle used to offer milk expressed with a breast pump. Parts of the pump also showed a pink coloration.Given the suspicion of Serratia colonization, cultures of breast milk, as well as the infant’s stool, urine, and oropharyngeal swab were collected. The mother was started on intramuscular ceftriaxone and was advised to suspend breastfeeding for 48 hours. The breast milk culture tested positive for Serratia marcescens, sensitive to sulfamethoxazole-trimethoprim. The infant’s cultures were negative.After maternal treatment, the new bottle and nipple used to offer formula to the infant still showed pink discoloration, and weight gain remained unsatisfactory. The infant was started on sulfamethoxazole-trimethoprim. After the treatment, no pink coloration was observed on the mother’s or the baby’s items.DISCUSSIONStudies have demonstrated that human milk undergoes fluctuations in macronutrient concentrations, with higher fat content at the end of feedings and during specific times of the day, particularly at night. These variations are physiological and not indicative of pathology, nor can they explain the pink discolouration of milk.Therefore, other causes must be considered, including nipple bleeding and microbial contamination [4]. Bleeding within the mammary ducts, often seen in the first postpartum days due to increased vascularization and suction-related trauma, can confer a pink or brownish hue to the milk. This condition, referred to as rusty pipe syndrome, is typically self-limited, poses no harm to the infant, and does not contraindicate breastfeeding, except when signs of infant intolerance or severe maternal pain are present [1,5].However, infectious causes must be considered when the pink coloration is persistent or occurs in hospital settings, particularly in neonatal units. Serratia marcescens, a Gram-negative bacterium from the Enterobacteriaceae family, is widely described as an opportunistic pathogen in neonatal intensive care units (NICUs). Its ability to produce pigments, form biofilms, and colonize medical devices renders it a potential threat in the NICU [6,7].S. marcescens is especially relevant in NICUs, and can cause septicemia, pneumonia, urinary tract infections, and meningitis, particularly in premature or immunocompromised neonates. Routes of contamination include breast pumps, reusable containers, and inadequately sanitized hands [6]. Early detection of the microorganism in breast milk or on hospital surfaces can prevent transmission to multiple neonates, especially when improper milk expression or room-temperature storage practices are involved [7].The association between pink breast milk and contamination by S. marcescens was first described by Hernández Marchant et al., who reported the so-called red diaper syndrome, characterized by reddish pigmentation of diapers in infants fed contaminated breast milk. This was one of the earliest reports linking the pigmentation to the prodigiosin-producing bacterium, contributing to the recognition of the phenomenon in pediatric literature [8]. Quinn et al. described a series of five cases of pink breast milk in neonatal units in the United Kingdom. In all cases, the coloration was associated with the presence of S. marcescens, confirmed by cultures of both the milk and the expression equipment. Notably, not all exposed neonates developed infection, suggesting that bacterial presence in milk may sometimes reflect asymptomatic colonization [9]. [10].Human milk contamination is largely preventable through safe handling practices, as outlined by CDC guidelines. Recommendations include proper hand hygiene, cleaning and sterilization of breast pumps and containers, and storage of milk according to guidelines. Prolonged exposure of milk to room temperature, promotes the proliferation of opportunistic bacteria such as S. marcescens [11,12].CONCLUSIONPink breast milk may have benign etiologies, such as nipple bleeding, but may also indicate contamination by pigmented microorganisms, with S. marcescens being the most prominent. Ongoing surveillance, combined with scientific and technical knowledge, supports evidence-based clinical decision-making and the maintenance of breastfeeding as a safe and recommended practice [1–12].REFERENCES1. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am. 2013;60(1):49-74. doi:10.1016/j.pcl.2012.10.002.2. Picciano MF. Nutrient composition of human milk. Pediatr Clin North Am. 2001;48(1):53-67. doi:10.1016/S0031-3955(05)70285-6.3. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841. doi:10.1542/peds.2011-3552.4. Mitoulas LR, Kent JC, Cox DB, Owens RA, Sherriff JL, Hartmann PE. Variation in fat, lactose and protein in human milk over 24 h and throughout the first year of lactation. Br J Nutr. 2002;88(1):29-37. doi:10.1079/BJN2002579.5. World Health Organization. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. Geneva: World Health Organization; 2009. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148965/6. Cristina ML, Sartini M, Spagnolo AM. Serratia marcescens infections in neonatal intensive care units (NICUs). Int J Environ Res Public Health. 2019;16(4):610. doi:10.3390/ijerph16040610.7. Voelz A, Müller A, Gillen J, et al. Outbreaks of Serratia marcescens in neonatal and pediatric intensive care units: clinical aspects, risk factors and management. Int J Hyg Environ Health. 2010;213(2):79-87. doi:10.1016/j.ijheh.2009.09.003.8. Hernandez Marchant R, Oyarce Rojas P, Arcaya O. Síndrome del pañal rojo. Infección por Serratia marcescens. Rev Chil Pediatr. 1960;31:335-339.9. Quinn L, Ailsworth M, Matthews E, Kellams A, Shirley DA. Serratia marcescens colonization causing pink breast milk and pink diapers: a case report and literature review. Breastfeed Med. 2018;13(5):388-394. doi:10.1089/bfm.2018.0002.10. Valle CA, Salinas ET. Pink breast milk: Serratia marcescens colonization. AJP Rep. 2014;4(2):e101-e104. doi:10.1055/s-0034-1387934.11. World Health Organization. Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: World Health Organization; 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK48781912. Centers for Disease Control and Prevention (CDC). Breast milk storage and preparation. 2025. Available from: https://www.cdc.gov/breastfeeding/breast-milk-preparation-and-storage/handling-breastmilkAuthors:Patrícia da Silva Fernandes, MD¹ Nicholas Embleton, MD, PhD² Ana Beatriz Gonçalves, MD, MSc³* * *This post is also published here on Substack.