Virtual reality as an assessment tool and a treatment method in the field of addiction.

Infants born preterm confront multiple coexistent and interacting health risks, making premature birth costly, morbid, and potentially deadly. Adverse medical and neurobehavioral outcomes are inversely correlated to gestational age (GA) at birth and thus, degree of organ system immaturity. Human milk (HM) generally provides an optimal nutrition source for preterm infants when appropriately fortified to meet the unique needs of premature life. When mother’s own milk is unavailable or contraindicated, the American Academy of Pediatrics recommends use of pasteurized donor HM instead of formula [,,]. Unfortunately, access to pasteurized donor HM is limited by availability and affordability. In situations where HM is inaccessible, preterm infant formula is needed to achieve and maintain enteral autonomy. To approximate the gap between HM and preterm infant formula and to improve health through use of HM fortifier, evaluation and use of differences in biologically active components are required. International guidelines on preterm nutritional care have listed several research priorities, including bioactive compounds such as human milk oligosaccharides (HMOs) []. HMOs comprise the third largest solid component of HM after lactose and lipids, respectively, and with concentrations exceeding 8 g/L from colostrum and human milk through the first month of life of preterm infants [,,,]. HMOs confer protection, resilience, and enhance organ development through multiple complementary mechanisms though specific concentrations and profiles vary by geography and lactation period, among other factors [,,]. 2′-Fucosyllactose (2′-FL) is one of the most abundant HMOs secreted by women, consisting of an alpha1,2-linked fucose attached to lactose. One of the functions of HMOs including 2′-FL is as a prebiotic with clinical and preclinical evidence of multifarious benefit, now commercially available in many term infant formulas. Added 2′-FL to term infant formula is well-tolerated in clinical trials, supporting typical infant growth and gut health [,,,,]. Preclinical evidence strongly suggests protection against NEC through various mechanisms including maintenance of mesenteric perfusion and inhibition of necroptosis [,,]. Furthermore, it may convey resilience to such a severe disorder, reducing NEC-induced brain injury and strengthening the adaptive response to bowel resection [,]. Indeed, 2′-FL is generally an anti-inflammatory and immune-modulating HMO with clinical evidence of lowering inflammatory cytokine levels when supplemented in term infant formula or obtained directly from HM [,]. Preclinical evidence also supports a positive influence of 2′-FL on cognition [,,]. We intentionally sought to conduct a prospective pilot study comparing 2′-FL supplementation to a placebo control among preterm infants born between 26 0/7 to 31 6/7 weeks gestation, stratified by HM source. The primary objective was to evaluate growth and tolerance of 2′-FL supplementation among preterm infants. Among infants randomized to receive the study supplement, 270 mg per day of 2′-FL was provided to give 2′-FL within the range of what preterm and term infants may receive [,,]. Measures of growth, intake, output, and tolerance were monitored throughout the study. Neurobehavior was evaluated with the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale (NNNS) [].