I would like to thank the author for the commentary on our recent paper (1). A simple answer is that ‘nutritional requirements are not easily gauged in preterm infants.' There are many reasons for this. It remains unclear whether the reference fetus (2) or the empiric approach (3) should be used to estimate requirements. Irrespective, requirements will vary between the sexes (4) and between infants who are appropriately grown and those who are growth retarded. Requirements may also be altered by the clinical condition of the infant. In effect, one recommendation is unlikely to meet needs in all infants.

For the purpose of our study, protein requirements were based on the reference fetus (2) and current recommendations for the enterally-fed infant (5). To control for the effects of sex and differences in nutritional status a balanced cross-over design was used. The ‘sick' unstable infant primarily receives parenteral rather than enteral nutrition and, therefore, was not appropriate. The somewhat older clinically stable and enterally-fed infant was chosen, as a first step in better defining needs for growth in this nutritionally bereft group of infants.

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