Please select the eligibility criteria that correspond to the clinical trial below.
Title: Early Supplementation of Enteral Lipid With Combination of Microlipid and Fish Oil in Infants With Enterostomy
Brief Summary: Necrotizing enterocolitis (NEC) and intestinal perforation are common in premature infants. Often surgery is needed to remove the dead bowel and create an ostomy (a temporary intestinal opening on the infant's abdomen). Infants with ostomies cannot digest and absorb food well, and must receive nutrition through the blood stream, i.e. parental nutrition (PN). However, prolonged dependence on PN can severely damage the liver and gut. Therefore, giving nutrition through the gut, i.e. enteral nutrition, is the primary treatment for infants with ostomies.

Enteral fats, especially polyunsaturated fatty acids (PUFA), are most beneficial in stimulating gut mucosal adaptation, which begins 24 to 48 hours following bowel resection. In addition, the premature intestine has a rapid growth rate. It is likely that the current clinical practice of giving a relatively low-fat diet to infants with ostomies may not meet their high metabolic needs.

The investigators hypothesize that increasing dietary fat content by early supplementation with MicroLipid® (ML, n-6 PUFA) and fish oil (FO, n-3 PUFA) to preserve the proper balance of n-6 and n-3 PUFA, may (i) improve bowel adaptation and infant growth; (ii) reduce the use of PN; and (iii) prevent liver damage and/or cholestasis (jaundice) in infants with ostomies.


Options:
A: Inclusion Criteria:

* Full term healthy newborn from normal pregnancy
* Newborn whose mother decided to not breastfeed or to stop breastfeed before the third week of life

Exclusion Criteria:

* Newborn with low-birth-weight (\<2500 g)
* Newborn whose parents have planned a move within 6 months after birth
* Family history of allergy to milk protein
B: Inclusion Criteria:

* preterm birth
* birth weight between 1000 and 2200 g
* more than 80 % of energy intake from infant formula or human milk at enrollment

Exclusion Criteria:

* apparent genetic, gastrointestinal or metabolic disorders
* artificial ventilation or oxygen supply \> 30% at the time of enrollment
* administration of parenteral fat emulsion (\> 1 g/kg/day for more than seven days) before or after study entry
C: Inclusion Criteria:

* infants (age range: newborn to 2-month-old) who are admitted to BCH NICU with a jejunostomy or ileostomy (from surgical intervention for NEC, bowel perforation, midgut volvulus (twisted bowel), atresia or other gastrointestinal surgery);
* who are expected to need full or partial PN for at least 21days from the day of enterostomy placement; and
* have received enteral feedings ≤ 4 days since enterostomy placement

Exclusion Criteria:

* infant with colostomy;
* infants with enterostomy but

  * unable to obtain written informed consent from parent;
  * presence of congenital liver or renal, or metabolic diseases; and
  * ostomy caused by gastroschisis, omphalocele, imperforate anus, and perinatal asphyxia
  * unable to initiate enteral feeds after 28 days of ostomy placement.
D: Inclusion Criteria:

* healthy term newborn
* gestational age between 37 and 41 weeks
* birth weight between the 3th and 97th weight-for-age percentile according to the EURO-Growth charts
* fully bottle-fed (at the latest with 28 days of age) or fully breast fed
* written parental informed consent
* Serbian nationality

Exclusion Criteria:

* malformations, congenital heart defect, congenital vascular disease, severe diseases of gastrointestinal tract, kidney, liver, central nervous system and/or metabolic disease
* intensive care during first 14 days of life
* participation in any other clinical study intervention
* twins, multiple birth
* neonatal infection
* medication and parenteral nutrition
* metabolic disorders
* birth-related complications
* severe disturbances of neonatal adaption

Answer: C