Objective:This study was designed to compare the efficacy and safety of enteral supplementation of a prebiotic mixture (SCGOS/LCFOS) on faecal microbiota in very premature infants who fed exclusively with human-milk.Methods:This double-center randomized control trial was conducted from December 2012 to November 2013 in the tertiary Neonatal Intensive Care Units of the Isfahan University of Medical Sciences. Fifty preterm infants (birth weight ≤1500 g who were not fed with formula) were randomly allocated to have enteral (tube feeding) supplementation with a prebiotic mixture (SCGOS/LCFOS; 9:1) or receive no prebiotics.Findings:The primary outcome (e.g., the effect of the prebiotic mixture on fecal microbiota pattern) was clearly different between the two groups. Despite greater coliforms colony counts in first stool cultures in the prebiotic group (Group P) (P = 0.67), coliforms were significantly lower in the third stool cultures in the Group P (P < 0.001). Furthermore, despite the much higher Lactobacillus colony counts, in the first stool cultures, in the control group (Group C) (P = 0.005); there was a trend toward significantly increased Lactobacillus colony counts in the Group P during the study, but the difference between Lactobacillus colony counts, in the third stool cultures, between two groups was no longer statistically significant (P = 0.11). Interestingly, the median length of hospital stay was significantly less in the Group P (16 [12.50–23.50] vs. 25 [19.50–33.00] days; P = 0.003).Conclusion:This suggests that it might have been “the complete removal of formula” which manifests a synergistic effect between nonhuman neutral oligosaccharides (prebiotics) and human oligosaccharides, which in turn, led to the rapid growth of beneficial Lactobacillus colonies in the gut of breast milk-fed preterm infants, while decreasing the number of pathogenic coliforms microorganisms. Therefore, further studies with larger sample sizes are recommended to investigate the issue.

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Introduction: Neonatal death due to infections is still a great concern worldwide. Umbilical cord related infections play significant role in the neonatal mortality specially in very low birth weight infants, mother chorioamnionitis and premature rupture of membranes. It is associated with umbilical colonization, delayed separation and poor hygiene. In the current study, effect of topical breast milk usage with dry cord care on separation time, complications and colonization were compared. Methods This is a randomized clinical-trial on 150 very low birth weight neonates in 2016-18. Patients' were divided in two groups; Group-M (N = 73) (3–4 drops of maternal breast milk were dropped on the umbilical cord stump within eight hours of birth and went on every eight hours until 48-hours after cord separation) and Group-D (N = 77) (the umbilical cord was drought gradually in open air). Umbilical cord culturing was performed from cord stump within 2–4 hours after delivery, three days after birth and at the day of separation. Cords were assessed considering omphalitis, bad smell, exudates formation and granulation tissue. Results Neonates of two groups were not statistically different regarding separation time (P = 0.09), incidence of omphalitis (P = 0.16), bad odor (P > 0.99), exudative secretions (P = 0.97), granulation tissue (P = 0.96) and sepsis (P = 0.13). In addition, hospitalization duration (P = 0.71), time to reach full enteral feeding (P = 0.31) and death (P > 0.99) were not statistically different. Three times cultures derived from two groups presented no significant difference (P > 0.05). Conclusion Based on findings of the current study, neither topical breast milk nor dry cord care was superior considering separation, associated complications and colonization. As neonatal death is still a serious concern worldwide and lacking of unanimous approach for prevention of cord related complications, further studies are strongly recommended.