From this one study -- it looks as though nutrition is more of a factor 
than immune protection in very small babies who are intended for the 
level of nutrition provided by placenta. Maternal nutrition is likely a 
factor here? Other comments?

"Neonatal nutrition and later outcomes of very low birth weight infants 
at Kenyatta national hospital."

"Background: Extensive research in developed countries has established 
that very low birth weight (VLBW) infants are particularly vulnerable to 
the effects of early nutritional deficiencies. There is, however, little 
information from poor countries on the long-term effects of these 
deficiencies in such infants. Objective: Determine the association 
between neonatal feeding regimens and post-discharge morbidity/ 
mortality and neurological abnormalities at the age of two years for a 
cohort of VLBW infants. Design: Prospective Cohort. Methods: One 
hundred and seventy five VLBW infants were recruited over a 
consecutive period of one year and followed up to the age of two years 
corrected for gestation. With neonatal feeding regimes as the exposure 
variable, post-discharge re-hospitalization, mortality and Saigal and 
Rosenbaum's functional disability assessment scores were compared as 
the outcome variables. Results: The 175 infants recruited into the study 
had median birth weight of 1400 +/- 103 grams and gestation 32 +/- 
2.3 weeks. The male:female ratio was 2:3 while 64 (36.6%) had been 
born intrauterine growth retarded. During the newborn period, 83
(47.4%), 35 (20.0%) and 57 (32.6%) of the infants fed on exclusive 
breast milk, pre-term formula and mixed preparations respectively. The 
median neonatal weight gain was 17 +/- 2.5, 15 +/- 2.0 and 13 +/- 3.9 
grams/kilo/day for preterm formula, combined and exclusive breast milk 
fed infants respectively. More of the infants fed on breast milk alone 
were re-hospitalized compared to those on pre-term formula, RR 2.3; 
95%CI 1.4-3.6 or mixed milk preparations, RR 1.9; 95% CI 1.4-2.7. 
Infants exclusively fed on breast milk had more neurological disabilities 
than those on pre-term formula alone, RR 3.2; 95% CI 1.2-8.1. Though 
only 22.9% of pre-term milk fed infants died compared to 36.1% of 
those on breast milk alone the difference was not statistically 
significant, P>0.05. Conclusion: Nutritionally enhanced enteral feeds 
during the first month of life appear to have reduced post-discharge 
morbidity and improved neurological outcomes at two years in VLBW 
infants."

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