The nutrition of preterm infants.

Although great efforts have been made to improve neonatal nutrition in very low birthweight (VLBW) infants, many do not receive adequate nutrient intake and thus develop extrauterine growth restriction. In order to minimize the interruption of nutrients that occurs at birth, an "aggressive" nutritional approach has been proposed. Parenteral nutrition, which allows the infant's requirements for growth and development to be met, is indicated in infants for whom feeding via the enteral route is impossible, inadequate, or hazardous. In the last few years, great attention has been given to high amino acid supply in VLBW infants from the first day of life in order to avoid catabolism, establish anabolism, achieve in utero protein accretion rates, and promote linear growth. Whenever possible, enteral feeding should commence with human milk, which is the preferred feeding method for all infants, including those born preterm. In order to meet the unique nutritional requirements of VLBW infants and preserve the singular benefit of breastfeeding, human milk should be fortified to allow adequate growth and bone mineralization. When feeding of preterm infants with human milk is impossible or extremely limited, cow-milk-based formulas for preterm infants must be used.