ABSTRACT. Background. Preterm infants are immunologically immature at birth. Previous studies have demonstrated that human milk protects against infection in full-term infants, but there are few studies of its effect for preterm infants.Objective. To examine the effect of human milk feedings on infection incidence among very low birth weight (VLBW) infants during their initial hospitalization.Study Design. The sample consisted of 212 consecutive VLBW infants admitted to the Georgetown University Medical Center neonatal intensive care unit (NICU) during 1992-1993 and surviving to receive enteral feeding. Type of feeding (human milk vs formula), presence of infection and sepsis/meningitis (clinical signs and positive cultures for pathogenic organisms), and potential confounding variables were abstracted from medical records. Multiple logistic regression was used to control for confounders. Conclusions. The incidence of any infection and sepsis/ meningitis are significantly reduced in human milk-fed VLBW infants compared with exclusively formula-fed VLBW infants. Pediatrics 1998;102(3). URL: http://www. pediatrics.org/cgi/content/full/102/3/e38; infection, sepsis, infant, low birth weight, human milk, breastfeeding. Results. The incidence of infection (human milk [29.3%] vs formula [47.2%]) and sepsis/meningitis (human milk [19.5%] vs formula [32.6%]) differed significantly by type of feeding. Major risk factors for infection were similar in both groups. Human milk feeding was independently correlated with a reduced odds of infection (odds ratio[ABBREVIATIONS. AAP, American Academy of Pediatrics; IgA, immunoglobulin A; VLBW, very low birth weight; NICU, neonatal intensive care unit; IV, intravenous; NPO, without enteral feedings; OR, odds ratio; CI confidence interval; EBM, expressed breast milk. I n a recent policy statement, the American Academy of Pediatrics (AAP) strongly advocated breastfeeding for full-term infants and for the first time extended this recommendation to premature infants.1 This statement from the AAP's Work Group on Breastfeeding cited the compelling advantages of human milk, which include immunologic benefits. Studies comparing human milk from preterm mothers with that from term mothers suggest that these immunologic benefits may be even greater for preterm infants because secretory immunoglobulin A (IgA), lysozyme, lactoferrin, and interferon are found in greater concentrations in preterm human milk compared with term milk.2-4 Very low birth weight (VLBW) infants do not benefit from the transplacental transfer of maternal immunoglobulins that occurs primarily after 34 weeks of gestation.5 These infants are exposed to abundant pathogenic organisms during neonatal intensive care unit (NICU) hospitalization and may benefit from the host defense factors present in preterm human milk. 6 -9 Although researchers have investigated the role of infant feeding type on the development of infection in full-term infants, 10 -15 the relation between type of infant feeding and infection among preterm inf...

This study shows that aggressive intake of AA and IL can be tolerated immediately after birth by VLBW infants. Also, ETPN significantly increased positive nitrogen balance and caloric intake, without increasing the risk of metabolic acidosis, hypercholesterolemia, or hypertriglyceridemia.

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Tracheobronchomalacia is common in neonates with bronchopulmonary dysplasia who undergo bronchoscopy and is associated with longer and more complicated hospitalizations.

Published models for severity of illness overpredicted hospital mortality in this set of VLBW infants, indicating a need for frequent recalibration. Discrimination for these severity of illness scores remains excellent. Birth variables should be reevaluated as a method to control for severity of illness in predicting mortality.