Extrauterine Growth Restriction: What is the Evidence for Better Nutritional Practices in the Neonatal Intensive Care Unit?

Extrauterine growth restriction (EUGR) is commonly seen in small premature infants due to a lack of early aggressive nutrition that results in energy and protein deficits during the first few days of life. These deficits lead to early postnatal growth failure that continues at discharge resulting in growth parameters being below the 10th percentile, which is associated with poor neurodevelopmental outcomes. Strong evidence supports an early aggressive nutrition plan that includes early parenteral nutrition administration with 3–4 g kg− 1 day− 1 of protein and minimal enteral feedings. This article presents the current evidence surrounding early aggressive nutrition, minimal enteral feedings, use of human milk and human milk fortification and makes the argument for standardized practice to improve nutrition in small premature infants.