Different pre-term formulas for different pre-term infants Silvia Fanaro ⁎, Elisa Ballardini, Vittorio Vigi Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Ferrara, Italy abstract article info Keywords: Pre-term infant Pre-term formula Protein/energy ratio Growth Body composition 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 b 0.0001) and lower energy intake (130 vs. 151 kcal kg –1 day –1 ; p b 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. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction In the last 2 decades, significant advances have been made in the type and quality of clinical care offered to infants born prematurely. This has led to important practical results, with neonatal intensive care units achieving astonishingly high survival rates, even in infants with a birth weight of b 1000 g. Despite the fact that, during this time, research on neonatal nutrition has also produced many important and significant achievements, there has certainly been a notable lack of work to integrate the many relevant results and findings obtained in the field of nutrition to the everyday clinical practice in neonatal units. The present situation is characterised by a lack of uniformity in the nutrition of very low birth weight (VLBW) infants and a marked disparity of practice in different institutions, where it is common to use several formulations – the composition of which is often largely similar and overlapping. It is a matter of concern that many clinicians are still reluctant to provide an early consistent amino-acid supply to pre-term infants in the first days of life, mainly due to unfounded concerns over elevated blood urea nitrogen concentrations, hyper- ammonaemia, metabolic acidosis and necrotising enterocolitis. The variation in nutritional practice in different institutions and the limited protein delivery rates generally offered to very pre-term infants are partly due to the difficulty in defining the nutrient intake needed to achieve growth and nutrient retention rates similar to those that would be achieved in utero and to the lack of reliable markers of protein adequacy and intolerance [1]. Optimal nutritional support for the newborn is presently consid- ered one of the most important tasks of the neonatologist, because of the short- and long-term effects on health and well-being. In the past, scientific interest was mainly focussed only on nutritional needs, whereas nutrition has now gained in its importance because of its role in the primary prevention of adult diseases and in the improvement of physical and cognitive potentials. This concept is described by the ‘programming’ theory, which identifies a critical period in life during which a stimulus or an insult may exert long-term consequences on the structure and function of the organism [2]. Unfortunately, human milk is not the reference standard for the nutrition of infants with high degrees of prematurity, because human- milk-fed pre-term infants may require nutrient supplementation or fortification to maintain an optimal nutritional status [3]. Breastfeed- ing, because of its anti-infective properties, immunomodulatory effects and favourable influences on intestinal microbiota, certainly offers relevant advantages for the growth of the very pre-term infant. However, it should be noted that, in some instances, it might limit the growth of extremely low birth weight (ELBW) infants, even after fortification. This can certainly be related to the limitations and problems encountered with available human milk fortifiers, the composition of which has not been satisfactorily upgraded. Thus, for various reasons, the availability and appropriate use of specific milk formulas, that can meet the needs of very small infants, have a central role in the general management of these delicate subjects. Early Human Development 86 (2010) S27–S31 ⁎ Corresponding author. Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Ferrara, via Savonarola 9, 44100 Ferrara, Italy. Tel.: +39 0532 206880. E-mail address: silvia.fanaro@unife.it (S. Fanaro). 0378-3782/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.earlhumdev.2010.01.005 Contents lists available at ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev