Nutrition in the very low birth weight infant.

In preterm infants an optimal nutritional supply must be provided early during the neonatal period. Indeed, undernutrition leads to growth retardation which may be hazardous for brain development (18). Growth rate is maximum during the last trimester of gestation and corresponds to about 60 cm/year (19). Therefore, contrary to young children, preterm infants after an arrest of growth, whatever the cause, cannot achieve a complete return to normal growth. This fact is clearly illustrated by the follow-up of very-small-for-gestational age infants in spite of a high protein, mineral, and energy intake. Oral nutrition alone cannot maintain adequate growth in very-low-birth-weight (VLBW) infants because of their poor clinical condition and the immaturity of their gastrointestinal tract. Total or supplemental parenteral nutrition has been shown to improve the neonatal growth of VLBW infants by enhancing their caloric and nitrogen supply (4,24). In this chapter, we shall present some guidelines about nitrogen, amino acid, energy, and mineral intakes for infants on total parenteral nutrition (TPN).