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Before vaccination against nH1N1 influenza was available in South Africa our hospital experienced an outbreak of nH1N1 infection on the maternal and neonatal platform. Oseltamivir was administered to nine low birth weight infants, five for therapy and four for prophylaxis. The median gestational age was 31 (27–37) weeks and the birth weight was 1660 (720–2360) g. Respiratory function improved in those with confirmed disease and none receiving prophylaxis developed worsening respiratory symptoms. One neonate receiving prophylaxis developed self-limiting conjunctivitis; another succumbed from necrotizing enterocolitis (NEC) three days post completion of oseltamivir treatment. A causal relationship between oseltamivir and NEC, although unlikely, cannot be confirmed or excluded.