Human Milk Fatty Acids in Pre-Eclampsia and Normotensive Mothers

Presenter: Nicola Harris, DO

Differences in fatty acid profiles have been reported in women with pre-eclampsia, but whether these differences are reflected in human milk after delivery is less well understood.

This retrospective, case-control observational study analysed existing human milk samples from the UTHealth Neonatal Intensive Care Unit (NICU) Biorepository to compare fatty acid profiles between mothers with pre-eclampsia and normotensive controls, with infants matched by gestational age. A total of 68 human milk samples from 63 mothers were analysed by gas chromatography: 30 samples were from mothers with pre-eclampsia and 38 from controls, including 7 repeated samples from mothers with pre-eclampsia. Compared with controls, milk from mothers with pre-eclampsia had lower total polyunsaturated fatty acids (18.67% ± 3.63% vs 20.58% ± 3.23%, p=0.02) and linoleic acid (14.98% ± 3.41% vs 17.56% ± 3.20%, p=0.002), but higher arachidonic acid (0.23% ± 0.18% vs 0.16% ± 0.07%, p=0.03) and docosahexaenoic acid (0.37% ± 0.19% vs 0.27% ± 0.14%, p=0.02). Other fatty acids were similar between groups.

The findings indicate differences in human milk fatty acid composition following pre-eclampsia, while the clinical implications for neonatal growth and morbidity remain under investigation.

Orally Feeding Hospitalized Infants and Children Who Require Noninvasive Respiratory Support: A Survey of Practice in the United States

Presenter: Carolyn K. Barnes, PhD CCC-SLP

The safety and efficacy of oral feeding during respiratory support with high-flow nasal cannula (HFNC) or nasal continuous positive airway pressure (nCPAP) remain poorly defined despite common clinical use.

This anonymous survey examined feeding practices and clinical decision-making among physicians and speech-language pathologists (SLPs) working in pediatric intensive care units (PICUs), pediatric cardiac intensive care units (PCICUs), and acute care units. Responses from 25 intensivists and 38 SLPs were included. Among respondents reporting nCPAP use (92.1%), 46.6% indicated that oral feeding could occur during nCPAP, but only 1 respondent (3.9%) reported using a unit protocol. Acceptable maximum nCPAP levels varied from 0–10 cm H₂O across age groups. Among those reporting HFNC use (92.1%), 98.3% permitted oral feeding, with maximum acceptable flow rates ranging from 0–5 L/min in neonates to 0–30 L/min in children. Intensivists and SLPs differed significantly in the importance assigned to age (p=0.0035), weight (p=0.0164), respiratory support level (p=0.0412), and unit protocol (p<0.0001), but not clinical stability, diagnostic trajectory, caregiver feeding reports, or personal feeding observation (p>0.05).

The findings demonstrate substantial variation in oral feeding practices and decision-making, supporting the need for safety and efficacy data to guide more consistent practice.

Driving Early Enteral Nutrition in the PICU: A Multidisciplinary QI Initiative to Achieve Feeding Within 48 Hours of Admission

Presenter: Marwa Mansour, MD, FAAP

Early enteral nutrition (EEN) within 48 hours of pediatric intensive care unit (PICU) admission is recommended for eligible critically ill children, yet timely initiation can be limited by clinical and logistical barriers.

This quality improvement initiative in a quaternary PICU aimed to increase the proportion of eligible patients receiving EEN within 48 hours by 20% above a baseline of 55% during January–June 2026. Eligible patients included critically ill children requiring respiratory support who were appropriate candidates for EEN; invasively ventilated patients were required to be hemodynamically stable, with mean arterial pressure above the 25th percentile for age and vasoactive inotrope score (VIS) <5. Interventions included a standardized enteral feeding protocol with trophic-to-goal advancement and targeted education for advanced practice providers and bedside nurses. The proportion receiving enteral nutrition within 48 hours increased from the baseline of 55% to 74% after protocol implementation and to 80% following education. Median time to nutrition order remained approximately 36 hours, while feeding tube placement was around 47%. Delayed or absent nasogastric tube placement was a commonly identified barrier. No increase in adverse events or feeding intolerance was observed.

The findings support standardized multidisciplinary protocols as a practical approach to improving timely EEN in the PICU.

Spontaneous Intestinal Perforation in Very Low Birth Weight Infants Exposed to Bifidobacterium Longum ssp. Infantis

Presenter: Cortnie R. Vaughn, MD

Spontaneous intestinal perforation (SIP) has become an important surgical bowel condition among very low birth weight (VLBW) and extremely low birth weight (ELBW) infants as early survival has improved, while the safety and potential role of probiotics in SIP remain uncertain.

This single-center, nonconcurrent retrospective cohort study evaluated human milk-fed VLBW infants before and after introduction of Bifidobacterium longum subspecies infantis EVC001 (B. infantis EVC001) in 2018, excluding infants with necrotizing enterocolitis (NEC). Among 521 VLBW infants, 262 were exposed and 259 were unexposed. SIP incidence was lower with EVC001 exposure (0.8% [2/262] vs 3.9% [10/259], p=0.02). In the ELBW subgroup, incidence was also lower (2.1% [2/95] vs 7.2% [7/97]), although this difference was not statistically significant (p=0.09). Adjusted analyses showed a consistent direction of association without statistical significance. No probiotic-associated adverse events occurred; one case of Bifidobacterium bacteremia was excluded because the infant had NEC.

The findings suggest a potential association between EVC001 exposure and lower SIP incidence, warranting prospective evaluation.

American Academy of Pediatrics (AAP) National Conference & Exhibition 2026, October 2–6, San Diego, California