Aggressive nutrition for preterm infants--benefits and risks.

Very preterm infants frequently develop growth failure while in neonatal units. Guidelines for protein and energy requirements have recently been revised to consider the fetal reference related to lean body mass and protein gain, rather than weight gain, with revised protein intakes up to 4.4 g/kg/day at 26 to 30 weeks gestation. To limit growth failure, parenteral nutrition (PN) with relatively high protein and lipid needs to be commenced on day one. Early PN should be accompanied by minimal enteral feeds at 5-20 ml/kg/day with enteral feeds being steadily and carefully increased. Mother's own milk is the feed of choice and fortification schedules need to be revised to better meet new guidelines. Providing early PN and grading of enteral feeds with human milk to full feeds and then fortification to meet revised guidelines should improve growth and development, reduce infection rates and avoid the risks associated with rapid catch-up growth.