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.

Hello everyone,CEPAS 2026 is getting close. The congress takes place in Lyon, 28–31 October, and 99nicu will be there - in the middle of things!Where to find usWe have a home base in the Meet & Connect Zone, in the Early Career Professionals' Space. Come by, say hello, ask questions, or just sit down for a moment between sessions. If you have ever posted here, or only read quietly for years, you are equally welcome. Our two sessions🗓️ Thursday 29 October, 10:10–10:25 — a short introduction to 99nicu, and the start of our Treasure Hunt. Small, fun, and a good excuse to talk to people you have never met.🗓️ Saturday 31 October, 12:45–13:15 — our Anniversary Session. We begin with an interactive clinical quiz, then open the floor for discussion. Twenty years of this community, and the best part is still the conversation.One practical reminderThe regular registration rate ends on 30 September. From 1 October, late rates apply. For example, the member fee goes from €550 to €685, and the early career / nursing rate from €315 to €390. So if you are planning to come, better book your spot this week.👉 Registration: https://www.cepas.org/registrationSee you in Lyon 👋

Living for Two: Twin Loss Stories is a 2023 book written by journalist and triplet Pia Rockström. It explores the profound and unique grief experienced by surviving twins, reflecting the feeling of some, of having to live both for oneself and one's lost sibling. I connected with Pia after we met through the Lone Twin Network and read her book including 20 stories of twin loss at birth, in childhood and in adulthood from around the world. All of the stories are beautiful and touching, and I asked Pia to share the story of her sister Maria, and of writing her book. When I read Pia’s story I was struck by how long Pia had held that grief, before even she ‘found’ it inside her. Almost half a century…Sara and Pia, twins but also tripletsPia RockströmIn memory of my sister Maria and all the twin souls who have gone firstWhen I was 54 years old, I was given access to my mother’s birth record. I saw in black and white the exact sequence of events, the October day in 1970 when my sisters and I were born. Ultrasounds did not become common in maternity care in Sweden until ten years later. Therefore, as a 23-year-old first-time mother, my mother came to the maternity ward in Lund with the belief that she was expecting one baby. It was only when she came in with contractions at week 35 that the staff discovered that there were three fetuses. That year, only seven of all births in Sweden were triplets. All three of us came into the world nine minutes apart. I, as number one, with my head first, just like my sister Sara who comes out number three. Between us, Maria is born breech. Maria is operated on for a left-sided diaphragmatic hernia and dies during the procedure.Pia and Sara the first month at Lunds hospitalWe rarely talked about Maria in the family. When she is mentioned at some point, it is more practical, like me celebrating my name day on her day, Maria Day, when my name is not in the calendar. We two surviving sisters are tight and do most things together. I therefore did not think of myself as someone who carried grief.It was only when I was over forty that the longing catches up with me during a yoga session. We travel through time, when we count down from our achieved age, with five-year intervals and feel what our body is telling us. I do not feel anything special in the exercise until the end when we have come down to the nine months that precede life. Then I burst into tears that couldn’t be stopped.I cry loudly in the room, it is many years of grief over my sister that comes up. The incident made me want to know more about the twin relationship and how other lone twins have experienced twin loss. As a journalist, I see my opportunity to spread information about a subject that is barely covered in my home country of Sweden. I take a leave of absence from work and spend a year interviewing around twenty twins from Sweden, the USA, the UK and Norway who have lost their twin at some point in their lives.if we had talked more about Maria at home, I would never have had to write a bookSometimes I have thought that if we had talked more about Maria at home, I would never have had to write a book. Now the book is my way of facing my feelings. And I have really healed by hearing other people’s stories. I have understood that I am not alone in the experience of walking with unconscious grief that has arisen in the middle of life. I met another set of triplets who lost their brother when they were two years old. When Jan, who came from the same egg as Alf, did a stomach massage at the age of 25, the grief over his brother came up.The parents were not told where the children who died wentI was also deeply moved by Ingrid, an lone twin who lost her sister at birth in 1950s Sweden. At that time, it was common for stillborn children to be buried in already open graves. The parents were not told where the children who died went. They were spoken of in silence, all pregnancies would end happily, it was seen as best that the parents had no relationship with the child.That interview made me search for Maria on a page of Swedish graves. For the first time, I saw her name in text, Maria Holmberg, Lund pastorate, which states the day of our birth but also the day she was buried. But the most healing thing is knowing that since the 1970s in Sweden, parents have been given the option to hold a funeral for children who die at birth. My parents got to say goodbye with a funeral where my sister lay in a small white coffin. Before that, she was also baptized and given her name, Maria.Grief can hide deep inside a twin who has lost their twin at birth, and it feels important to share that fact.It is so easy for those around them to only see twins who have lost their twin in their teenage years or as adults. But grief for someone with whom you shared the time of conception can leave deep traces. The bond is already created in the womb and is permanent. Important research that can explain the depth of such grief has been done by Italian psychotherapist Alessandra Piontelli. Through ultrasound, she has followed twins’ relationship with each other in the fetal stage. She has categorized their behavior in the womb as “the playing pair”, “the hostile pair” and “the hugging pair”. She has then shown that the relationship patterns they have with each other in the womb tend to continue even after birth.My interviews eventually became the Swedish book Leva för två, which was translated into the English book Living for two, published by Free Association Books in London. It was only after the book was finished that I got to see my mother’s birth record. Thanks to that, I had the opportunity to meet the midwife who took me and my sisters in. I found her name in the birth record and learned from a mutual acquaintance that she was now over eighty years old. Even though she, Anita, did not remember our birth, it was nice to meet her with my sister Sara and share all her experience. She had only been a practicing midwife for three years when she had her first triplets, and then worked in the profession for almost fifty more years.The more I open up and let Maria be a part of my world, the more powerful and strong I feelI can recommend that parents of lone twins allow the surviving twin to see the birth record when they are old enough. The record clearly showed me that my sister was in such a bad condition that life on earth was not preferable. I could read how the medical staff made several attempts to keep her alive, how she was met with professionalism, which has helped me accept that I did not get to share life here on earth with her. I also hope that my book Living for two will provide comfort in that I and other twins often feel a kind of connection with our twin siblings after a loss. It’s as if the bond is so strong that not even death can break it. I’ll tell you more about my experiences of meeting other lone twins in a future post.Nick EmbletonUntil I became an attending neonatologist, I would never have imagined this situation existed; that there may have been a triplet pregnancy but where only two babies survived. It’s possible that as a resident or fellow I met families like this; I don’t know or remember. I had always been aware that we struggled to know what to do, or say, on the NICU when there were twins, where only one baby survived, and that led to the Butterfly Project. Triplets are much less common, and the challenges faced when there are only two survivors are unique. Not better or worse than singleton loss, or twin loss. But unique and different. I have now met several triplet families like Pia, and their stories are profound and deeply moving.I don’t know what the “take home” message from Pia’s story is. There are probably many. But every time I listen to parents or siblings speak or write like this it continues to strike me what a privileged life I have led.Pia carried her grief for Maria for almost half-a-century before she realised it was there. I never thought that could happen. Of course, it’s possible to suppress ‘trauma’ for years, but Pia’s grief was and is different.I have heard health professionals caring for bereaved families say, or heard from the parents direct that they’ve been told, “you’ll get over it”. If there’s an important take away for health professionals from Pia, it is that the grief of baby loss lives with you forever.We never know what someone else is going through. We will never know what it feels like to be Pia, or Dani or the other siblings and parents who will write here in the Butterfly project. I hope it makes all of us behave and act with more kindness, compassion and gratitude.* * *This post is also published here on Substack.

dear sirI have a baby with a possible diagnosis of methemoglobinemia. What is the dose and duration of treatment with methylene blue? And after how many doses can signs of response to treatment be seen?