Babies that are born extremely prematurely are at higher risk of developing a serious inflammatory condition, called necrotizing enterocolitis (NEC), that damages parts of the intestines. It is the most common cause of illness of the intestinal tract in premature infants in the first few weeks of life. It is a very serious condition that can lead to death in up to half of affected infants.The main purpose of this study is to see if IBP-9414 ( a probiotic) can prevent NEC and if it is safe and tolerable.

IBP-9414 (Lactobacillus reuteri) is a live bacterial therapy given to infant's through a feeding tube or it is given by mouth once daily starting at or before 48 hours of life. IBP-9414 will be given daily until the infant reaches 34 weeks + 6 days Post-Menstrual Age (PMA) (the the baby's gestational age at birth plus the postnatal days of life), or until treatment is permanently discontinued if earlier.

Breastfeeding is important for the development of the immune system of the infant. Emerging data suggest that vitamin D plays an important role in immunity as well. Exclusively breastfeeding mothers and their infants will be studied in a 3-month (4-study visit) pilot study of vitamin D supplementation versus placebo. Longitudinal effects of vitamin D status on breast milk composition and on the infant's immune system will be examined.
Additionally, exclusively breastfeeding mothers who are currently on vitamin D supplementation will be studied at a single visit, at which mothers will provide a single breastmilk sample and have a single blood sample obtained. These samples will be used to examine effects of vitamin D supplementation on breast milk composition.