Background and Aim: Very-low-birth-weight (VLBW) neonates may develop severe intolerance to standard preterm formula especially if they are associated with intrauterine growth restriction (IUGR). We tested the hypothesis that these infants may tolerate an elemental, amino acid–based formula as a rescue feeding strategy.

Methods: In a prospective, case-control pilot study, we enrolled VLBW IUGR infants enterally fed with standard preterm formula (SPF) at daily increments of 16 mL/kg. If gastric residuals accounted for >70% of milk feed in the previous 24 hours, then feedings were temporarily withheld and then resumed with amino acid formula (AAF) increased at the same speed. Cases on AAF were compared to controls on SPF and with cases themselves while on SPF. Primary outcome was the time to reach full enteral feedings. Secondary outcomes were time on parenteral nutrition, time on central venous catheter, and formula tolerability based on the amount of gastric residual volume.

Results: 64 infants (22 cases) were enrolled. Although during the total duration of nutrition, cases had worse primary and secondary outcomes, when on AAF, cases were comparable to controls in time to full enteral feeding (14,4 vs 14 days), time on parenteral nutrition, and time on central venous catheter.

Cases on AAF and controls had similar gastric residual volumes.

At day 3 after AAF introduction, cases had a significantly reduced number (%) of gastric residual volume >5 ml/kg over total number of feedings (5,6 vs 1,5%; p<0,05) and the mean gastric residual volume (2,7 vs 0,6 ml; p<0,05) compared to themselves while on SPF. No difference was detected in weight at 21 and 28 days, in main serum parameters and outcome at discharge. Growth at 12 months of corrected age was also comparable.

Conclusions: In our population of VLBW IUGR newborns with severe feeding intolerance, a short course on AAF was a safe and effective means of nutritional rescue.

Aim: Necrotizing enterocolitis (NEC) represents one of the gravest complications in premature infants.

The suggested role of intestinal microbiota in the development of NEC needs to be elucidated.

Methods: This prospective single-centre case–control study applied barcoded pyrosequencing to map the bacterial composition of faecal samples from extremely preterm infants. Ten patients were diagnosed with NEC and matched to healthy controls with regard to sex, gestational age and mode of delivery prior to analysis of the samples.

Results: Enterococcus, Bacillales and Enterobacteriaceae dominated the flora. Although not statistically significant, a high relative abundance of Bacillales and Enterobacteriaceae was detected at early time points in patients developing NEC, while healthy controls had a microbiota more dominated by Enterococcus. A low diversity of intestinal microbial flora was found without any differences between NEC patients and controls. In 16 healthy controls, Firmicutes (Enterococcus and Bacillales) dominated the faecal flora during the first weeks after birth and were then succeeded by Enterobacteriaceae.

Conclusion: No significant differences in the composition of intestinal microbiota of patients developing NEC were detected; however, some findings need to be scrutinized in subsequent studies.

Background. Intestinal failure (IF) affects a growing number of children due to increasing numbers of preterm infants surviving intestinal resection for necrotising enterocolitis and improving surgical techniques for congenital gut anomalies.

Parenteral nutrition (PN) is the mainstay of therapy; enteral nutrition may have trophic effects on the gut.

Aim.To review systematically evidence for the effectiveness of medical and nutritional interventions in the treatment of IF in children.

Methods. Retrieval of data from studies of patients aged <18 years and receiving >28 days of PN. Outcome measures were improvement in intestinal function, intestinal adaptation, growth, prevention and treatment of IF-associated liver disease, and mortality. Cochrane Database (November 2009), MEDLINE (1950–November 2009) and CINAHL (1982–November 2009) electronic database searches were made using keyword and subject headings (MeSH): IF, Short Bowel Syndrome (SBS), PN and Child. The level of the evidence (EL) was assessed using SIGN (Scottish Intercollegiate Guidelines Network) methodology (http://www.sign.ac.uk).

Results. From 1 607 620 hits, 720 abstracts were reviewed.

Thirty-three original articles were included. No studies were of high methodological quality.

Conclusions. The evidence base for medical and nutritional interventions in paediatric IF is limited and of poor quality.

In the absence of randomised-controlled trials, this evidence base can improve through case control and cohort research; and with better multiagency communication, the study of inter-centre differences is possible. Achievable short-term goals would include the study of: optimal ursodeoxycholic usage, novel intralipid formulations, cycled enteral antibiotics, enteral probiotics and new enteral feeding strategies.

Objectives: We studied the effect of preparing donor human milk (DHM) with commonly used nutritional additives on the dialyzability of calcium and phosphate. We hypothesized that the additives to DHM would decrease the dialyzability of calcium and phosphate when prepared according to hospital protocols.

Methods: An in vitro system simulating premature infant digestion was developed to measure dialyzability of calcium and phosphate in DHM. Dialyzable calcium and phosphate were measured after in vitro digestion in DHM before and after preparation of DHM with the following additives according to hospital protocols: calcium glubionate, sodium potassium phosphate, calcium glubionate and sodium potassium phosphate added together, Similac human milk fortifier, Similac NeoSure, or Enfamil Enfacare.

Results: The percentage of dialyzable calcium in DHM with added calcium and calcium and phosphate together was greater than the percentage of dialyzable calcium in DHM with added powdered infant formulas (p<0,0001). Dialyzable calcium was greater in DHM with added calcium and with added calcium and phosphate than in all other treatment groups (p<0,0001).

Dialyzable calcium in DHM without additives was not different from dialyzable calcium in DHM with added phosphate or with added powdered infant formulas. Dialyzable phosphate did not differ between the treatment groups.

Conclusions: The addition of calcium alone or calcium and phosphate together increased calcium dialyzability in DHM significantly, whereas the addition of powdered human milk fortifier or formulas did not. The addition of calcium or calcium with phosphate together to DHM may provide the most dialyzable calcium.

In recent years the incidence of atopic diseases such as asthma, atopic dermatitis (AD), allergic rhinitis and food allergy have increased significantly. AD is a chronic skin disease characterized by pruritic, inflamed skin. It has been estimated that prevalence of AD in school age children in western countries ranges from 10 to 20% and in the United States. In addition to the skin problem, AD has been associated with a series of complications, including clinical, behavioral, and financial distress , including treatment and discharge period. On the other hand, prevalence of allergy has increased and although the reasons for this are multifactorial, it has been seen that protein content in infant formula is one of the factors that contribute to its development. Exclusive breastfeeding has been shown to be protective of problem.

However, when for whatever reason an infant cannot be breastfed, partially hydrolyzed predominantly whey protein formula in a lower concentration than in regular infant formula, has been shown to be effective in prevention of the manifestations of AD, and highly cost-effective in the prevention of atopic dermatitis compared to standard formula, proven in randomized, controlled studies. Among other factor that could affect the manifestation of AD is development of the fecal flora of the newborn infant is thought to be related to several factors such as the mode of delivery (vaginal vs. cesarean section (CS), place of delivery (home versus hospital). The fecal flora of babies delivered by CS is quite different than that of vaginally delivered babies. Increasingly, epidemiologic and clinical data support the hypothesis that perturbations in the gastrointestinal microbiota disrupt the normal microbiota-mediated mechanisms of immunological tolerance in the intestinal mucosa, leading to an increase in the incidence of allergies, in particular, allergic airway disease and other ailments, including type I diabetes and overweight. Probiotics are beneficial bacteria to the host and multiple studies have demonstrated the benefits of many of them. In addition, administration of probiotics in feeding may be a way to overcome the problems caused by an abnormal development of the fecal flora. Among one of the most studied probiotics is Bifidobacterium lactis, known as BB12.

Others include Lactobacillus GG, Lactobacillus reuteri. The effects of probiotics are species specific. It is not possible to extrapolate results from studies done with one particular strain of a probiotic to prevent or treat one condition, to another bacterial or yeast strain or to treat other conditions.

There is a certain circle of congenital heart diseases in the neonatal age, which can potentially threaten to children live. In a modern cardiac surgery the distinct tendency to performance of primary radical operations in neonatal period is noted. First of all, it concerns critical congenital heart diseases at which palliative operations earlier were carried out. Actual there are questions of early and exact localization diagnosis adequate to presurgical therapy and a choice of optimum surgical tactics. Purpose of this issue was to present a condition of a problem of definitive repair of congenital heart diseases to newborns according to domestic and foreign literature.