Objectives: Cryptosporidium is a water-borne risk to US citizens. It is associated with severe watery diarrhea in immunocompromised patients similar to preterm infants. Preterm infants may be exposed to contaminated water via the common practice of using water to warm formula or expressed breast milk, or via nosocomial routes such as poor hand-washing technique. The purpose of this study was to investigate the presence of Cryptosporidium in the premature newborn population (birth weight< 1500 grams) and to determine if an association between Cryptosporidium infection and NEC exists.

Study Design: A prospective study was done over an 18 month period. Once every 1-2 weeks milk and stool specimens of infants < 1500 grams in birth weight hospitalized in the newborn intensive care unit were analyzed for Cryptosporidium by an enzyme-linked immunoassay(ELISA). This assay was used to detect Cryptosporidium-specific antigen in aqueous extracts of fecal specimens (sensitivity 97%, specificity 98%) and milk specimens. Daily data collection included the infants' clinical status, feeding patterns, and presence of gastrointestinal symptoms and actions taken. The mean postnatal age at which the first milk and first stool specimen were collected was 6.7 days. 84% of the studied populations had 4 or more specimens tested. Infants had to have at least 2 specimens to be included in the study.

Results: 67 infants met the study criteria. Birth weights were 38 infants (57%) 1001-1500 grams, 17 (25%) 801-1000 grams, 12 (18%) 500-800 grams. 14 infants (22%) developed NEC (95% CI 13-34%). 4 deaths occurred (6%), one related to NEC. All specimens tested were negative for Cryptosporidium-specific antigen, including 266 stool specimens (95% CI 0-2%), and 120 milk specimens (95% CI 0-3%), 66 of which were expressed breast milk (95% CI 0-5%).

Conclusion: Cryptosporidium was not isolated in the premature infants or their milk supply during their hospital stay in the NICU. We conclude that Cryptosporidium is not associated with NEC in the population we studied.