Nutritional care of the extremely premature infant.

In summary, the nutritional care of extremely premature babies includes special attention to glucose homeostasis and fluid and electrolyte balance in the immediate postnatal period. Parenteral nutrition should be started routinely on the 2nd or 3rd day of life, if the infant is metabolically stable, and continued until the infant is receiving sufficient enteral feedings to promote growth. If not clinically contraindicated, minimal enteral feedings should be started before the end of the first week of life. The decision to either advance or maintain minimal enteral feedings at a constant level should take into account the clinical status of the infant. Fortified preterm human milk is the preferred feeding and premature infant formulas, the best substitute. Multivitamin supplements may be necessary, depending on formula intake. Iron supplements can be initiated as early as 2 weeks of age and high levels of intake appear to be necessary during erythropoietin therapy.