Optimal protein and energy intakes in preterm infants

There is compelling evidence that current nutritional practice fails to provide sufficient dietary protein for preterm infants, especially extremely and very low birth weight infants. Nutrient requirements can be estimated by a variety of techniques, but most suggest that these infants will require a protein intake of 3.5–4.0 g/kg/d. Even when these infants are able to tolerate full enteral feeds, most currently available artificial milk formula or breast milk fortifiers will not ensure these protein requirements are met except when fed at high volumes. Energy requirements on the other hand may be currently met, and evidence from controlled studies suggests that intakes higher than 110–135 kcal/kg/d might not be beneficial. The data from studies on neonatal adiposity outcomes, and from studies examining relationship between early growth and later cardiovascular outcome, also suggest that excess nutrient intake might be harmful. In the light of this data, optimal intakes and protein–energy ratios require re-appraisal.