ImportanceEarlier egg and peanut introduction probably reduces risk of egg and peanut allergy, respectively, but it is uncertain whether food allergy as a whole can be prevented using earlier allergenic food introduction.ObjectiveTo investigate associations between timing of allergenic food introduction to the infant diet and risk of food allergy.Data SourcesIn this systematic review and meta-analysis, Medline, Embase, and CENTRAL databases were searched for articles from database inception to December 29, 2022. Search terms included infant, randomized controlled trial, and terms for common allergenic foods and allergic outcomes.Study SelectionRandomized clinical trials evaluating age at allergenic food introduction (milk, egg, fish, shellfish, tree nuts, wheat, peanuts, and soya) during infancy and immunoglobulin E (IgE)–mediated food allergy from 1 to 5 years of age were included. Screening was conducted independently by multiple authors.Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used. Data were extracted in duplicate and synthesized using a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation framework was used to assess certainty of evidence.Main Outcomes and MeasuresPrimary outcomes were risk of IgE-mediated allergy to any food from 1 to 5 years of age and withdrawal from the intervention. Secondary outcomes included allergy to specific foods.ResultsOf 9283 titles screened, data were extracted from 23 eligible trials (56 articles, 13 794 randomized participants). There was moderate-certainty evidence from 4 trials (3295 participants) that introduction of multiple allergenic foods from 2 to 12 months of age (median age, 3-4 months) was associated with reduced risk of food allergy (risk ratio [RR], 0.49; 95% CI, 0.33-0.74; I2 = 49%). Absolute risk difference for a population with 5% incidence of food allergy was −26 cases (95% CI, −34 to −13 cases) per 1000 population. There was moderate-certainty evidence from 5 trials (4703 participants) that introduction of multiple allergenic foods from 2 to 12 months of age was associated with increased withdrawal from the intervention (RR, 2.29; 95% CI, 1.45-3.63; I2 = 89%). Absolute risk difference for a population with 20% withdrawal from the intervention was 258 cases (95% CI, 90-526 cases) per 1000 population. There was high-certainty evidence from 9 trials (4811 participants) that introduction of egg from 3 to 6 months of age was associated with reduced risk of egg allergy (RR, 0.60; 95% CI, 0.46-0.77; I2 = 0%) and high-certainty evidence from 4 trials (3796 participants) that introduction of peanut from 3 to 10 months of age was associated with reduced risk of peanut allergy (RR, 0.31; 95% CI, 0.19-0.51; I2 = 21%). Evidence for timing of introduction of cow’s milk and risk of cow’s milk allergy was very low certainty.Conclusions and RelevanceIn this systematic review and meta-analysis, earlier introduction of multiple allergenic foods in the first year of life was associated with lower risk of developing food allergy but a high rate of withdrawal from the intervention. Further work is needed to develop allergenic food interventions that are safe and acceptable for infants and their families.

NMDA glutamate receptors (NMDARs) have critical functional roles in the nervous system but NMDAR over-activity can contribute to neuronal damage. The open channel NMDAR blocker, memantine is used to treat certain neurodegenerative diseases, including Parkinson's disease (PD) and is well tolerated clinically. We have investigated memantine block of NMDARs in substantia nigra pars compacta (SNc) dopamine neurones, which show severe pathology in PD. Memantine (10 μM) caused robust inhibition of whole-cell (synaptic and extrasynaptic) NMDARs activated by NMDA at a high concentration or a long duration, low concentration. Less memantine block of NMDAR-EPSCs was seen in response to low frequency synaptic stimulation, while responses to high frequency synaptic stimulation were robustly inhibited by memantine; thus memantine inhibition of NMDAR-EPSCs showed frequency-dependence. By contrast, MK-801 (10 μM) inhibition of NMDAR-EPSCs was not significantly different at low versus high frequencies of synaptic stimulation. Using immunohistochemistry, confocal imaging and stereological analysis, NMDA was found to reduce the density of cells expressing tyrosine hydroxylase, a marker of viable dopamine neurones; memantine prevented the NMDA-evoked decrease. In conclusion, memantine blocked NMDAR populations in different subcellular locations in SNc dopamine neurones but the degree of block depended on the intensity of agonist presentation at the NMDAR. This profile may contribute to the beneficial effects of memantine in PD, as glutamatergic activity is reported to increase, and memantine could preferentially reduce overactivity while leaving some physiological signalling intact.

Aim Extremely preterm infants are separated from their mothers immediately after birth and not placed skin‐to‐skin in routine neonatal intensive care unit settings. Visual and physical contact in the delivery room as a first cuddle potentially can facilitate early parent‐infant interaction and reduce the trauma of separation. Our aim in this study was to explore mothers' experience of delivery room cuddle by collecting qualitative feedback via emotional mapping. Methods Six mothers experiencing delivery room cuddle had been recruited (GA of their babies 24 + 5–29 + 0 weeks, birth weight 540–1019 g). Using a descriptive qualitative approach, semi‐structured interviews were performed with six mothers following consent via Zoom or phone between September 2020 and March 2021. Interviews were transcribed using AI Otter and then analysed using thematic analysis. Results Analysis of the participants' experiences revealed five themes: fears and hopes around delivery; the moment of delivery—recognising uncertainty; reclaiming normalcy; forming connections; and the journey ahead as an empowered parent. Conclusion All mothers reported positive emotions about the cuddle with their baby. They highlighted that this physical contact was often the only positive and ‘normal’ birth experience they had from the time of delivery.

Background There has been a lot of interest in therapeutic hypothermia (TH) for hypoxic ischaemic encephalopathy (HIE), and increasingly, neonates suffering ischaemic insult receive TH. However, we have yet to elucidate the best feeding regime. There is some data for adult TH but limited work has been done in neonates. Aim To assess current feeding practice in neonates undergoing TH for HIE. Methods 25 neonates who received TH at Addenbrooke’s hospital in 2012 were identified from the TOBY trial register. Baseline demographics, details of clinical condition and feeding protocols were recorded. Results The age at starting enteral feeds had a wide range (2–7 days) but most reached full feeds by 6–10 days. Three suffered gastrointestinal complications and reached full feeds later (initially day 7, 11, 28, maintained by day 17, 21, 28 respectively). Metabolic markers were not correlated with day enteral feeds started. HIE grade was related to feeding practice (see table). Abstract PC.78 Table % Given PN Average age started enteral feeds Average age at full feeds GI complications Enteral Enteral + Parenteral HIE 1 0 2.3 N/A 8 0 HIE 2 27.3 2.9 7.7 10 2 HIE 3 28.6 3.5 5.5 9.3 1 All 21.7 2.9 6.8 9.6 3 Conclusions Despite concerns about optimising nutrition in HIE, most reached full feeds by day 10 suggesting little detrimental effect from the delay in enteral feeds. Identifying those at risk of developing GI complications remains important. However, the data did not reveal any obvious objective markers (metabolic markers or HIE grade) for risk.

Background The NICE guidelines for cooling in hypoxic ischaemic encephalopathy (HIE) have resulted in increasing numbers of babies being cooled. Optimising nutritional intake in intensive care is increasingly viewed as important, but there is limited guidance on risks verses benefits associated with either enteral or parenteral (PN) feeding routes. Aim To determine current clinical practice across the UK regarding feeding in babies being cooled for HIE. Method A telephone questionnaire to all units that are listed as cooling centres in the TOBY register (n = 67). One of 3 investigators spoke to either the nurse in charge or doctor (middle grade or above). Results 62 centres responded (93%). Clinical practice varied widely between centres, most having no specific feeding guidelines. 28 units (45%) did not feed during cooling, 25 (40%) said they would normally feed but dependent on clinical condition, and 9 reported using trophic feeds or occasionally feeding. Of those who would feed during cooling, the decision to feed was predominantly related to ventilator status, use of inotropes and/or lactate level. Most centres recommended EBM, 7 considering DBM if EBM was not available. Rate of milk increase varied widely. 34 units (55%) routinely started PN early while cooling, 9 rarely used PN, 4 used PN post cooling, 8 considered PN if there was significant delay in oral feeding, and 6 reported use to be very baby dependent. Conclusion There is a wide range in current nutritional management of babies being cooled. Further work is needed to determine optimal management.