A number of reasons for concern about early nutritional management of very low birthweight (VLBW)infants, particularly extremely low birthweight (ELBW) infants, are enumerated by the authors of the articles in this issue. These include the possibilities that current management practices result in excessive losses of limited endogenous nutrient stores, fail to preserve host defense mechanisms, and do not promote normal growth and development of the central nervous system. An additional related concern is that these practices result in growth deficits of sufficient magnitude to prevent or hinder achievement of the infants’ growth potential.

As Thureen notes, a number of studies have shown that reasonably stable infants who receive no protein or amino acid intake during the initial 7 to 10 days of life lose at least 1% of endogenous protein stores daily. Further, Premer and Georgieff suggest that sick infants may lose even more protein stores. Clearly,this loss cannot continue...

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