Nutrition & Feeding

Ann-Marie Brennan gave a clear tour of the human milk fortification evidence, built around three questions: which fortifier, how to fortify, and when to start. She ended with the Irish national experience of integrating fortification with parenteral nutrition. Why fortify at all Unfortified human milk at 150–180 ml/kg/d provides only about 2–2.3 g/kg/d of protein. Even at very high volumes it covers only around 50–60% of the lower ESPGHAN limit for calcium and phosphorus. Multinutrient fortification (macronutrients plus minerals) improves in-hospital growth without increasing adverse effects. ESPGHAN 2022 recommends a multinutrient fortifier. Individualized strategies (ad…

This CEPAS poster presents data on the effects of enteral arachidonic acid (ARA) and docosahexaenoic acid (DHA) supplementation on the developing gut microbiome. The researchers analysed stool samples from 75 extremely preterm infants participating in the MegaDonnaMega trial of ARA/DHA supplementation, using a multiomics approach. In short, they combined microbiome, bacterial gene pathways and protein analyses. ARA/DHA supplementation was associated with changes in gut microbiome composition. The analyses also identified changes in bacterial metabolic pathways and protein profiles. Gestational age, study centre, and sepsis were also associated with substantial effects on …

Dear community Who decides when a preterm infant is ready to feed by mouth, and how do we diagnose dysphagia? Three recent papers prompted this question. Reynolds et al. (J Perinatol 2026) describe a level IV NICU where every VP/VLBW infant has a structured clinical feeding evaluation by a certified neonatal therapist (SLP or OT) once unit-based criteria for oral feeding are met. Mothers are offered 1–2 weeks of protected breastfeeding first. Infants who still struggle around 38 weeks PMA, despite positioning, pacing and slow-flow nipples, go on to FEES. Dysphagia was defined as laryngeal penetration with or without aspiration, and it was confirmed in 25% of the cohort. O…

Every August, the world pauses to mark International Breastfeeding Week — a moment to celebrate not just a biological act, but a public health priority with lifelong consequences. Human milk is uniquely suited to protect and nourish infants, and this is nowhere more critical than in the smallest, most vulnerable patients: extremely preterm babies. For these infants, mother's own milk — and, when unavailable, donor human milk — is not a lifestyle choice but a medical intervention, reducing the risk of necrotizing enterocolitis, late-onset sepsis, and supporting long-term neurodevelopment. Initiating, protecting, and sustaining lactation for a mother whose baby may spend mo…

Hypoglycemia is a common cause of neonatal admission and is often managed with dextrose infusion albeit the early use of 40% glucose gel may have reduced admission rates. Our South Australian guideline recommends IV Dex 10% bolus and infusion at 90/kg/day if BGL is below 1.5 mmol/L, and also recommends iv Dex 10% at 60 ml/kg/day if sugars are between 1.5 and 2.5 despite enteral feeds of 30 mL/kg/day. But what is the role for higher rates of enteral feeding on Day 1 in the otherwise well infant without significant respiratory distress? Breastfeeding and EBM where possible, but also either a term formula (~7.5 g carb/100mL) or preterm (8.3 g/100mL) with the additional optio…

Dear NICU-colleagues I would like your expertise in a patient case. We have a preterm infant born at 28+2 weeks of gestation following PPROM and chorioamnionitis, treated with SALSA for RDS, and subsequently managed on HFNC until a week ago. The infant is now at 34+0 weeks postmenstrual age and is off all respiratory support. Aside from this, the infant is very healthy, with no IVH, no PDA, and adequate growth. Enteral nutrition was initiated with donor breast milk, and the infant reached full enteral feeds of 150 mL/kg by 7 days of age. The infant’s mother has complex epilepsy and was maintained on Tegretol (carbamazepine) 800 mg + 1200 mg/day, Briviact (brivaracetam) 20…

Hello to the 99 Community, As a teritary unit now rising to the challenge of delivering and optimising the care of our nano prem infants can I enquire if any Units have identified particular challenges of nutritional delivery and surveillance (parenteral and enteral) biomarkers (UE/LFT/Bone/Trigs etc) Thank you in advance. Here's to the next 20 years of the '99' Al

Dear colleagues, good day to all! Allow me to share with you some thoughts on non-nutritive feeding. We all know the important role of non-nutritive sucking, its significance in the formation of a healthy infant gut microbiota and psychological comfort for mother and child. But we rarely consider the differences in the structure of the nipple skin from the rest of the skin. The nipple skin is extremely resistant to mechanical and chemical stress, and the breastfeeding period is a case in point. Any other area of skin becomes malignant as a result of chronic mechanical and chemical trauma associated with breastfeeding. Any area, but not the nipple skin. And I thought about…

Dear Colleagues and Neonatology Experts, We are currently rewriting our internal protocols regarding bacteriological screening and CMV management of maternal milk (MOM) for hospitalized preterm infants. While our primary goal is maximum safety, we are guided by the principle of non-maleficence (Primum non nocere). This creates a complex clinical challenge: how do we protect the infant from potential pathogens (infection risk) without causing harm by destroying vital bioactive and immunological components through over-processing (nutritional/developmental risk)? Furthermore, we must avoid the harm of unnecessarily discarding precious breastmilk—a practice that exhausts res…

I’d love to hear from the 99NICU community about your go-to references. A few years ago, our team cared for a remarkable mother whose story reminded us how much nuance—and teamwork—breastfeeding counseling can require. She had undergone a liver transplant as a teenager and remained on lifelong anti-rejection medications. Years later, she delivered a healthy full-term baby and had a strong, heartfelt wish to breastfeed. As you can imagine, her medications raised questions about safety and infant exposure. Instead of defaulting to “no,” our team—neonatologist, clinical pharmacist, and the mother’s own transplant specialist—reviewed each drug carefully. We dove deep into pha…