The introduction of solid food is necessary for any infant in order to provide adequate nutrition because when they grow up milk is insufficient for their nutritional needs. Infants born preterm have increased nutritional requirements. The high nutrient demands as well as the organ immaturity of preterm infants combine to render it difficult to achieve dietary intakes that will allow preterm infants to match their in utero growth rates. Current guidelines for the introduction of solid food to term infants cannot be directly translated to preterm infants. For preterm infants such guidelines are lacking. Based on the limited available evidence, it could be concluded that a corrected age of 3 months (13 weeks) may be an appropriate age to start introducing solid food for most preterm infants. About celiac disease (CD), gluten may be introduced into the infant’s diet anytime between 4 and 12 completed months of age. In children at high risk for CD, earlier introduction of gluten (4 vs 6 months or 6 vs 12 months) is associated with earlier development of CD autoimmunity (defined as positive serology) and CD, but the cumulative incidence of each in later childhood is similar. Relatively to weaning and allergies, the European Society of Pediatric Allergy and Clinical Immunology and the European Society for Paediatric Gastroenterology Hepatology and Nutrition have produced joint guidelines. They recommend exclusive breastfeeding for 4–6 months or use of hypoallergenic formulas if exclusive breastfeeding is not possible. In addition, The American Academy of Pediatrics recommendations now state that there is no evidence to recommend maternal dietary restrictions during pregnancy or breastfeeding. However, there is no evidence that delaying introduction of solids including allergenic foods after 4–6 months is protective.

A full-term 9-day-old girl presented with fever, irritability, and seizures. The routine CSF examination, cranial ultrasound, and laboratory tests were normal. Brain MRI showed diffuse white matter abnormality (figure). Human parechovirus (HPeV) type 3 was isolated in both CSF and blood. The neurodevelopmental outcome at 4 months is poor, and MRI shows an extensive cystic leukomalacia in the frontal white matter.The diagnosis of HPeV infection can be made from a positive HPeV PCR in CSF and blood. Extensive white matter abnormality is a typical MRI finding in neonatal HPeV encephalitis, whereas herpes simplex virus encephalitis exhibits diffuse gray and white matter changes. 1 AUTHOR CONTRIBUTIONSVincenzo Belcastro and Paolo Bini: drafting/revising the manuscript for content, including medical writing for content; analysis or interpretation of data; study supervision or coordination. Mario Barbarini and Roberta Barachetti: analysis or interpretation of data; drafting/revising the manuscript for content, including medical writing. STUDY FUNDINGNo targeted funding reported. DISCLOSUREThe authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures. MRI T2-weighted spin-echo axial section (A) shows punctate white matter lesions (arrows) suggestive of petechial hemorrhages. Diffusion-weighted imaging section (B) shows diffuse excessive high signal intensity. This distinctive pattern of white matter involvement is noteworthy, and these abnormalities extend into the subcortical white matter and involve entire fiber tracts, corpus callosum, optic radiation, and posterior thalamus.From the Departments of Neurosciences (V.B.) and Neonatology (P.B., R.B., M.B.), S.

Preterm infants are at risk for poor growth while in the Neonatal Intensive Care Unit (NICU) and after discharge from the NICU. The main objective is to reach the body composition and rate of growth of a normal fetus/infant of the same post-menstrual age during the first entire year of life. In case of human milk, the limited data do not provide convincing evidence that feeding preterm infants after discharge with multi-nutrient fortified human milk, compared with unfortified, affects important outcomes including growth rates during infancy. Conversely, if formula-fed, post discharge formulas produce short term advantages in growth rate but no long term advantages are demonstrated. It is very important to establish a feeding plan and a follow up for all preterm babies who are discharged from NICU in order to recognize as soon as possible any growth deficit.