Different pre-term formulas for different pre-term infants

Optimal nutrition is one of the most important aspects in the care of pre-term infants, especially for the gestationally youngest ones. These infants should receive a supply of nutrients that can sustain growth similar to that of a third trimester normal foetus. Traditional pre-term formulas do not ensure an optimal protein supply except when fed at high volumes, with an excess of fat and carbohydrates. Formulas with a protein content of 2–2.5 g 100 ml–1 and a protein/energy (P:E) ratio of less than 3 g 100 kcal–1 are not the best choice for the very low birth weight (VLBW) infants. We have tested a new formulation designed for the nutrition of the VLBW infants that is characterised by a protein content of 2.9 g 100 ml–1 and a P:E ratio of 3.5 g 100 kcal–1. The milk formula was well tolerated and associated with better weight gain compared with fortified breast milk (18.1 vs. 15.2 g kg–1 day–1; p = 0.0015). These results were obtained with a noticeably lower fluid supply (157 vs. 177 ml kg day–1; p < 0.0001) and lower energy intake (130 vs. 151 kcal kg–1 day–1; p < 0.0001). Infant length and head circumference did not differ significantly between groups.Currently, the use of a formula with a P:E ratio of 3.5 g 100 kcal–1 appears to be safe and to represent the best choice available for the gestationally youngest infants.