Despite advances in neonatal medicine, preterm and very low birth weight(VLBW)  infants have substantial mortality and morbidity, often resulting from late-onset neonatal sepsis (LONS) and necrotizing enterocolitis (NEC). This is attributed to a large extent to the  immature immune system in these infants which predisposes them to increased risk of infection associated morbidity and mortality.

Preterm  infants are functionally immunodeficient , have immature intestinal mucosal barrier, require multiple invasive lines and procedures as part of their care. In addition to these, long term exposure to pathogens in neonatal intensive care unit(NICU) , overuse of antibiotics, delayed initiation of enteral feeds, presence of  gastric tubes and  multiple intravenous lines are factors that predispose VLBW infants to increased risks of sepsis and other co-morbidities like NEC, intraventricular hemorrhage  (IVH) etc. During breastfeeding or oral feeding of breast milk, the lymphoid cells in the oral mucosa get stimulated which leads to development of oral mucosa associated lymphoid tissue. The development of acquired immunity via breastfeeding and oral feeding has proven role in prevention of infection associated morbidity like LONS and NEC. Colostrum is the milk produced during the first few days after birth. It contains various substances that provide immunity in high concentration, to newborn babies. Even small volume of colostrums contains increased concentrations of secretory immunoglobulin A (sIgA), growth factors, lactoferrin, anti-inflammatory cytokines, pro inflammatory cytokines, and other protective components, compared with mature breast milk.  Mother’s milk contains many biofactors which are immunomodulatory in nature. Lactoferrin, one of many biofactors contained in mother’s milk, can protect against LONS and NEC via various mechanisms. Clinical instability and  immaturity precludes enteral feeds for extremely premature infants in the first days of life. Even when started, in infants with gestation less than 31weeks, enteral feeds have to be  given  via a gastric tube because of undeveloped or poorly developed coordination of swallowing, breathing and sucking. This bypasses the infant’s oropharynx and therefore, the infant’s oropharynx is not exposed to protective (immune and trophic) milk biofactors until oral feeds are introduced several days later. To overcome this handicap of the immature infant, oral application of colostrum and mother’s own milk has been tried in very low birth weight infants and shown to be safe and feasible. It has been shown to improve  the concentrations of several immune substances in the urine, saliva and tracheal secretions as well as decrease the levels of inflammatory substances like Interleukin-10. Oral application of colostrum has also shown benefits in achieving full feeds earlier and decreasing the duration of parenteral nutrition. we plan to conduct a randomized controlled trial  of oral application of colostrum  and placebo to study the effects on above listed clinical outcomes in preterm infants of 26 to 30 weeks gestation.