Nutrition for the Sick Preterm: Can We Make It More Precise?

The history of neonatal intensive care is fraught with struggles as to how to best nourish preterm infants for the best possible outcomes. During the early era of modern neonatal intensive care, the 1970s, up to the last decade it was common practice to withhold parenteral and enteral nutrition in preterm infants for fear of causing metabolic imbalances and inducing intestinal injury. These infants have very low energy and protein stores and are thus highly susceptible to undernutrition and catabolism. In the early era of neonatal intensive care (about 5–6 decades ago), many nutritional approaches were based largely on the physician’s intuition, previous experience, and patient signs and symptoms. Not all physicians had similar previous experiences, and there were numerous different approaches to care. This resulted in heterogeneity of diagnostic, preventative, and therapeutic measures.