Enteral nutrition of the very low birth weight (VLBW) infant.

INTRODUCTION Optimal nutrition is critical in the management of the very low birth weight (VLBW) infant. METHODS The type of feeding, initiation, route and schedule of feeding, and the rate of increase in feeding volume were reviewed. RESULTS Human milk from the preterm infant's mother is the feeding of choice. When full enteral feeding is established, supplementation of human milk with a multi-nutrient fortifier is required. In VLBW infants having poor weight gain when exclusively fed human milk, feeding of hindmilk is encouraged if the mother expresses large quantities of breast milk. Lactation support is vital for the mother, including appropriate methods of milk collection, storage and transport to the nursery. In mothers who produce no or insufficient human milk, preterm formulas are an alternative feeding, used either alone or in conjunction with human milk. Minimal enteral nutrition using sub-nutritional feedings in the first week of life is advantageous. Intragastric intermittent ("bolus") tube feeding is the route of choice for the infant born at < 32 to 34 weeks gestational age. Feeding volume must be advanced cautiously at < 20 mL/kg/day. CONCLUSION Future goals of nutrition research in the VLBW infant must include determining the role and optimal composition of the various nutrients and duration of use.