About

Josef Neu, M.D., is a Professor in the Department of Pediatrics, Division of Neonatology at the University of Florida College of Medicine. He received his Bachelor of Arts Degree in 1971 from Wisconsin State University, Whitewater, WI, and his Medical Doctorate in 1975 from the University of Wisconsin, Madison, WI. Dr. Neu completed his Pediatrics Residency at Johns Hopkins Hospital, Baltimore, MD, from 1975 to 1978, followed by a Postdoctoral Fellowship in Neonatology at Stanford University Medical Center from 1978 to 1980. In 1987, he completed a Sabbatical at Inselspital, University of Bern, Switzerland. His research interests include developing an updated taxonomy of intestinal injuries, often called necrotizing enterocolitis, as well as precision nutrition utilizing artificial intelligence and multiomics. He is the principal investigator of the Connection Trial, an international prospective randomized trial aimed at reducing major morbidities and mortality in preterm infants. Dr. Neu's work spans basic mechanisms of nutrients in cell cultures, animal models, and translation to human infants, with a focus on the effects of amino acids, nutrients, intestinal microflora, probiotics, and nutritional agents on neonatal development and diseases such as retinopathy of prematurity. He is also the Chairman of the Board of the IPOKRaTES Foundation, involved in global educational activities, and has received several honors and awards, including the Avroy Fanaroff Education Award in 2024 from the American Academy of Pediatrics.

Research topics

• Medicine
• Intensive care medicine
• Bioinformatics
• Pediatrics
• Biology
• Nursing
• Gynecology
• Obstetrics
• Internal medicine
• Immunology
• Pathology
• Physiology

Selected publications

• The future neonatologist

  Seminars in Fetal and Neonatal Medicine · 2026-04-01

  article1st authorCorresponding
  PublisherDOI

• Nutrition in infants with hypoxic-ischemic encephalopathy: insights from a single-center experience on parenteral and enteral feeding during therapeutic hypothermia

  The Journal of Maternal-Fetal & Neonatal Medicine · 2025-12-03 · 2 citations

  articleOpen access

  BACKGROUND: Therapeutic hypothermia (TH) is standard of care for neonates ≥36 weeks with hypoxic-ischemic encephalopathy (HIE). Although intravenous fluid restriction is common, optimal strategies for parenteral and enteral nutrition remain unclear. This study evaluated the tolerance of parenteral nutrition (PN) and enteral feeding in neonates undergoing TH, as well as the impact of these interventions on clinical outcomes. METHODS: We retrospectively reviewed charts from the Florida Neonatal Neurologic Network (FN3) of neonates who underwent TH for HIE between 2012 and 2020. Collected data included demographics, neurologic assessments, nutritional strategies, laboratory values, and MRI findings. Statistical analysis was performed using one-way ANOVA, with results expressed as Kruskal-Wallis p-values. RESULTS: < 0.05). CONCLUSIONS: Early nutritional support, including PN and enteral feeding, appears to be well-tolerated in neonates undergoing TH for HIE. These findings suggest that providing early nutrition may enhance neurodevelopmental outcomes and promote growth during TH.

  PublisherDOI

• Quantification and comparison of anti-AAV9 and anti-AAVrh74 antibodies in plasma and human milk: Implications for AAV-based gene therapy candidacy

  Journal of Neuromuscular Diseases · 2025-04-10 · 2 citations

  articleOpen access

  Background The application of recombinant adeno associated virus (rAAV) in gene therapy is accepted as an effective strategy for the treatment of monogenic diseases. However, eligibility for such therapies is contingent upon the absence or minimal presence of antibodies against adeno-associated virus (AAV) capsid protein. While the passive transfer of maternal immunoglobulins in utero is well established, the potential impact of maternal antibodies transferred via breastfeeding remains less explored. Objective This study aims to quantify and compare the levels of anti-AAV9 and anti-AAVrh74 immunoglobulin G (IgG) and M (IgM) in both plasma and human milk from a group of healthy lactating mothers. Methods In this cross-sectional study, we analyzed plasma and human milk samples from healthy lactating mothers. We used an enzyme linked immunosorbent assay (ELISA) to determine the levels of circulating IgG and IgM antibodies against AAV9 and AAVrh74 capsids and compared their concentrations in the paired samples. Results Thirty-one paired plasma and human milk samples were analyzed. The median age at participation was 34 years (range: 25–43), median duration of breastfeeding at the time of sample collection was 7.5 months (range:0.7–33), and median body mass index was 23 Kg/m 2 (range: 19.7–35.4). Median anti-AAV9 IgG in plasma and human milk, were 183 U/mL (range: 29–7214) and 1 U/mL (range: 1–33), respectively. Median anti-AAVrh74 IgG, in plasma and human milk were 138 U/mL (range: 23–8725) and 1 U/mL (range: 1–27), respectively. The differences in anti-AAV9 and anti-AAVrh74 IgG levels between plasma and human milk were statistically significant (p &lt; 0.0001). Additionally, a strong correlation (r: 0.97, p: &lt; 0.0001) was observed between anti-AAV9 and anti-AAVrh74 IgG levels in plasma. Conclusions The levels of anti-AAV9 and anti-AAVrh74 antibodies in human milk are remarkably lower than those in plasma. Consequently, breastfeeding should not be restricted for term infants who are potential candidates for AAV-related gene therapy products.

  PublisherDOI

• The Long‐Term Effects of Gut Microbiota of Premature Babies and Adult Health

  Acta Paediatrica · 2025-08-25

  articleOpen accessSenior author

  A proposed mechanism of how early life microbiota predisposes to later metabolic syndrome. Preterm intrauterine growth restricted (IUGR) infants compared with their appropriate for gestational age (AGA) counterparts carry a double burden. Both groups of infants experience catch-up growth mainly in the first 2 years of life. Later, they may be predisposed to develop cardio-renal-metabolic adverse sequelae [1], particularly in cases of “excessive”, unhealthy growth. The type of catch-up growth depends on several factors, including fetal programming, early nutrition, and gut microbiota [1]. Although many of the implicated factors have been extensively explored, the literature on preterm gut microbiota is restricted. Therefore, we aimed to search existing evidence concerning differences between the microbiota of AGA and IUGR preterm infants. The following parameters were considered: composition of their gut microbiota, their microbiota-depended catch-up growth, and the later resulting deleterious effects. It is known that preterm infants present a divergent gut microbiota compared to term infants. This is mainly due to their immature intestinal tract and immune system [2]. Furthermore, different microbial exposures at birth and postnatally, including mode of delivery, antibiotic administration, absence of lactation, and formula feeding, are implicated. Thus, the gut microbiota of preterm infants is characterised by delayed colonisation, decreased number of bacterial species, and lower diversity. Possible abundance of pathogenic facultative anaerobes (e.g., Enterobacter, Escherichia, Klebsiella) and scarcity of commensal strictly anaerobic organisms (e.g., Bifidobacterium, Bacteroides, Clostridium) may occur [3]. Focusing on preterm infants, limited studies showed differences in gut microbiota between AGA and IUGR infants. It has been reported that preterm small for gestational age (SGA) infants on postnatal day 30 presented in their stool lower Klebsiella and Enterobacter abundances. Additionally, the bacteria from this group clustered separately from those of the AGA group [4]. Studies in animal models confirm differences in the gut microbiota of IUGR and AGA offspring. Relatively, pathogenic bacteria, including Enterococcus and Enterobacteriaceae, were higher in the faecal samples of 2 to 11-week-old fetal growth restricted (FGR) pups of Sprague Dawley rats [5]. Concerning rapid catch-up growth and higher body mass index (BMI) in preterm SGA infants, increased risk has been documented for renal injury. This is due to their smaller nephron number, higher renal dysfunction, decreased glomerular filtration rate (GFR) and increased microalbuminuria. Also, increased risk exists for higher blood pressure, insulin resistance, obesity, and cardiovascular problems even in childhood [6]. The effect of the gut microbiota on catch-up could rely on various mechanisms. Thus, changes in the expression of genes associated with growth and modifications in metabolic pathways could be implicated. Relatively, research has shown that the gut microbiota impacts the somatotropic axis by regulating insulin-like growth factor 1 (IGF1) and growth hormone production [7]. Furthermore, it has been documented that increased body weight was associated with decreased Lactobacillus and increased short-chain fatty acids (SCFAs). The latter are involved in the synthesis of lipids and glucose [8]. Seminal research had already stressed the critical role of the gut microbiota in shaping lean and obese phenotypes [9]. Later literature reports that several pathologies, comprising obesity and metabolic syndrome, present an imbalanced gut microbiota [10]. Hence, divergent and more pathologic early gut microbiota may be implicated in excessive catch-up growth. Moreover, it may predispose to worse cardio-renal-metabolic sequelae in preterm IUGR, compared with preterm AGA subjects. Therefore, prematurity associated with IUGR versus prematurity associated with AGA should be considered a more deleterious condition, seen also from the gut microbiota perspective. Interventions might target a balanced microbiota that could train the immune system, influence growth hormone production, and protect the gut barrier. Such interventions comprise a healthy diet during pregnancy, vaginal delivery, breastfeeding, and possibly manipulation of intestinal microbiota by dietary or biotherapeutic means. Nevertheless, focusing only on the microbiota may be a bit simplistic. Several mechanistic factors should be considered in this complex relationship between early microbial colonisation and the developmental origins of health and disease. Interactions between the host and the microbial milieu in specific environments obviously play a role. Altered gene expression profiles (transcriptomics) and epigenomics with DNA methylation changes, histone modifications in genes related to metabolism and growth likely play important roles. Multiomic integration via metabolite and proteomic expression should be considered. Incorporation of these mechanisms into a systems biology approach can provide a more in-depth understanding of mechanisms of action. At the same time, it may provide biomarkers for those individuals at greatest risk. Summing-up, an improved perception of the mechanisms along with early identification will enable the development of targeted strategies for prevention which may include nutritional, pharmaceutical, and environmental modulators. A.M-.P. conceptualised the paper and wrote the manuscript. D.D.B. and J.N. revised and edited the manuscript. All three authors have read and consented to the last version of the manuscript. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no new data were created or analysed in this study.

  PublisherOA PDFDOI

• Digital twins, synthetic patient data, and in-silico trials: can they empower paediatric clinical trials?

  The Lancet Digital Health · 2025-05-01 · 34 citations

  reviewOpen accessSenior author

  Randomised controlled trials are the gold standard to assess the effectiveness and safety of clinical interventions; however, many paediatric trials are discontinued early due to challenges in patient enrolment. Hence, most paediatric clinical trials suffer from lack of adequate power. Additionally, trials are expensive and might expose patients to unproven therapies. Alternatives to overcome these issues using virtual patient data-namely, digital twins, synthetic patient data, and in-silico trials-are now possible due to rapid advances in digital health-care tools and interventions. However, such digital innovations have been rarely used in paediatric trials. In this Viewpoint, we propose using virtual patient data to empower paediatric trials. The use of virtual patient data has the advantages of decreased exposure of children to potentially ineffective or risky interventions, shorter trial durations leading to more rapid ascertainment of safety and effectiveness of interventions, and faster drug approvals. Use of virtual patient data could lead to more personalised treatment options with low costs and could result in faster clinical implementation of interventions in children. However, ethical and regulatory concerns, including replacing humans with digital data, data privacy, and security should be addressed and the safety and sustainability of digital data innovation ensured before virtual patient data are adopted widely.

  PublisherOA PDFDOI

• Ensuring Uninterrupted and Protected Progress in Caring for the Extremely Fragile Infant through Smart Policy and Sound Science

  Journal of the Academy of Public Health · 2025-01-01

  article
  PublisherDOI

• Sex-Related Nutritional Outcomes Among Preterm Very Low Birth-Weight Infants

  Advances in Neonatal Care · 2025-03-07 · 1 citations

  articleSenior author

  BACKGROUND: Sex-specific differences exist in morbidity and growth yet little is known about other nutritional outcomes in preterm very low birth-weight (VLBW) infants. This is important because providing optimal nutrition is essential to promote growth and reduce neurodevelopmental impairment. PURPOSE: To determine the effect of sex on days to full enteral feedings and other nutritional outcomes. METHODS: This was a longitudinal 2-group cohort study using secondary analysis of existing data of 313 infants born ≤32 weeks gestation and weighing ≤1500 g. Information regarding nutritional outcomes was obtained from the infant's electronic medical records. RESULTS: While not statistically significant, male infants reached full feeds nearly 3 days later (18.1 vs 15.2; P = .89), required parenteral nutrition for nearly an additional 4 days (18.3 vs 14.1; P = .37), and had a central line for 3 days longer (19.6 vs 15.7; P = .65) than female infants. Males had higher direct bilirubin levels ( P = .02), more emesis ( P = .003), and more late-onset sepsis ( P = .03). Birth weight for males was higher at birth but not at 6 weeks and while the slope of weight increase over the 6 weeks was higher in males ( P = .04), growth velocity was similar between sexes yet tended to be higher in females. IMPLICATIONS FOR PRACTICE AND RESEARCH: Nurses are essential in ensuring preterm infants in the neonatal intensive care unit receive optimal nutrition. This study supports nurses should consider sex-specific differences in nutritional outcomes among VLBW infants in precision based nutritional support.

  PublisherDOI

• Neonatal microbiome in the multiomics era: development and its impact on long-term health

  Pediatric Research · 2025-02-28 · 8 citations

  reviewOpen access1st author

  The neonatal microbiome has been the focus of considerable research over the past two decades and studies have added fascinating information in terms of early microbial patterns and how these relate to various disease processes. One difficulty with the interpretation of these relationships is that such data is associative and provides little in terms of proof of causality or the underpinning mechanisms. Integrating microbiome data with other omics such as the proteome, inflammatory mediators, and the metabolome is an emerging approach to address this gap. Here we discuss these omics, their integration, and how they can be applied to improve our understanding, treatment, and prevention of disease. IMPACT: This review introduces the concept of multiomics in neonatology and how emerging technologies can be integrated improve understanding, treatment, and prevention of disease. We highlight considerations for performing multiomic research in neonates and the need for validation in separate cohorts and/or relevant model systems. We summarise how the use of multiomics is expanding and lay out steps to bring this to the clinic to enable precision medicine.

  PublisherOA PDFDOI

• Gastrointestinal (GI)-lung-brain axis

  Seminars in Fetal and Neonatal Medicine · 2025-04-09

  reviewSenior author
  PublisherDOI

• Nutrition for the extremely low birthweight infant: past, present and future

  BMJ Nutrition Prevention & Health · 2025-01-16

  articleOpen access1st authorCorresponding

  How to provide optimal nutrition for extremely low birthweight (ELBW) infants has been a challenge over the past several decades.

  PublisherOA PDFDOI

Frequent coauthors

• Nan Li

  Jinan Maternity And Care Hospital

  49 shared

• Leslie A. Parker

  Florida College

  48 shared

• Vincent G. DeMarco

  Harry S. Truman Memorial Veterans' Hospital

  40 shared

• Diomel de la Cruz

  University of Florida

  33 shared

• Dominick J. Lemas

  32 shared

• Kellym Liboni

  University of Florida

  29 shared

• Mark A. Atkinson

  University of Florida

  28 shared

• Jennifer J. Schoch

  28 shared

Education

• B.A.

  Wisconsin State University, Whitewater, WI

  1971

• M.D.

  University of Wisconsin, Madison, WI

  1975

• Other, Pediatrics Residency

  John Hopkins Hospital, Baltimore, MD

  1975

• Other, Postdoctoral Fellow in Neonatology

  Stanford University Medical Center, Stanford, CA

  1978

• Other, Sabbatical

  Inselspital, at the University of Bern, Switzerland

  1987

Awards & honors

• Avroy Fanaroff Education Award 2024