Fatemizadeh R, Mandal S, Gollins L, et al. - Researchers conducted this prospective single-center observational cohort study to evaluate incidence of spontaneous intestinal perforation (SIP) and stage II or greater necrotizing enterocolitis (NEC) in extremely low birth weight (ELBW, ≤ 1,000 g) infants receiving a 100% human milk-based diet, and to characterize mortality rates of ELBW infants with SIP and NEC. The sample consisted of ELBW infants born between 2010 and 2014 with SIP or NEC, excluding those with congenital anomalies and death within 48 hours. Three hundred forty-five out of 379 ELBW infants were eligible. The incidence of SIP is greater than NEC in ELBW infants using an exclusive human milk-based diet. This indicates a changing pattern in the incidence of these two conditions in the era of human milk; NEC was more prevalent in ELBW infants previously. No differences were found in survival outcomes in both SIP and NEC groups based on surgical management.