Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Recommended nutrition for preterm infants—on track, but more research is needed

Abstract

In this issue of Pediatric Research, Naseh, et al. document that extremely to very preterm infants fed recommended macronutrient intakes using early parenteral nutrition and early and reasonably rapidly advanced enteral feeding of supplemented maternal and donor milk have relatively common outcomes of brain size and morphology at term gestational age and cognition at 2 years of age. Growth rates, ranges of data, and data for individual infants would have been helpful to better assess the impact of the feeding approaches and macronutrient intakes on growth and development of the study infants, but the success of Naseh, et al.’s feeding approaches and meeting recommended macronutrient intakes is encouraging.

Impact

  • Preterm infants who are fed recommended macronutrient intakes using early parenteral nutrition and early enteral feeding of supplemented maternal and donor milk have relatively common brain size and morphology at term gestation and cognition at 2 years.

  • These results expand the literature documenting that following rational feeding guidelines produces more optimal nutritional outcomes of preterm infants.

  • Early enteral feeding helps produce more optimal nutrition for preterm infants.

  • More research is needed to produce more optimal intravenous amino acid and lipid products and more optimal feeding approaches, and assess longer term growth, neurodevelopment, and cogniation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Naseh, N. et al. Impact of early nutrition on brain development and neurocognitive outcomes in very preterm infants. Pediatr. Res. https://doi.org/10.1038/s41390-025-03964-8 (2025). (PR-2024-1535.R1).

    Article  PubMed  Google Scholar 

  2. Rossholt, M. E. et al. A standardized feeding protocol ensured recommended nutrient intakes and prevented growth faltering in preterm infants < 29 weeks gestation. Clin. Nutr. ESPEN 53, 251–259 (2023).

    Article  PubMed  Google Scholar 

  3. Embleton, N. D. Optimal protein and energy intakes in preterm infants. Early Hum. Dev. 83, 831–837 (2007).

    Article  PubMed  CAS  Google Scholar 

  4. Poppe, T. et al. PIANO study group. Neonatal Nutrition and Brain Structure at 7 Years in Children Born Very Preterm. JAMA Netw. Open 8, e2456080 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rozé, J.-C. et al. Association Between Early Amino Acid Intake and Full-Scale IQ at Age 5 Years Among Infants Born at Less Than 30 Weeks’ Gestation. JAMA Netw. Open 4, e2135452 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Das, S. et al. High protein intake on later outcomes in preterm children: a systematic review and meta-analysis. Pediatr. Res 97, 67–80 (2025).

    Article  PubMed  Google Scholar 

  7. Stensvold, H. J. et al. Early Enhanced Parenteral Nutrition, Hyperglycemia, and Death Among Extremely Low-Birth-Weight Infants. JAMA Pediatr. 169, 1003–1010 (2015).

    Article  PubMed  Google Scholar 

  8. Thureen, P. J. & Hay, W. W. Jr. Early aggressive nutrition in preterm infants. Semin Neonatol. 6, 403–415 (2001).

    Article  PubMed  CAS  Google Scholar 

  9. Morgan, C. & Burgess, L. High Protein Intake Does Not Prevent Low Plasma Levels of Conditionally Essential Amino Acids in Very Preterm Infants Receiving Parenteral Nutrition. JPEN J. Parenter. Enter. Nutr. 41, 455–462 (2017).

    Article  CAS  Google Scholar 

  10. Chan, A. P., Rostas, S., Rogers, S., Martin, C. R. & Calkins, K. L. Parenteral Nutrition in the Neonatal Intensive Care Unit: Intravenous Lipid Emulsions. Clin. Perinatol. 50, 575–589 (2023).

    Article  PubMed  Google Scholar 

  11. Elke, G. et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit. Care 20, 117 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Anand, R. & Nangia, S. Influence of Early Total Enteral Feeding in Preterm Infants with Respiratory Distress Syndrome. Neonatology 122, 4–10 (2025).

    PubMed  CAS  Google Scholar 

  13. Razzaghy, J. et al. Early and exclusive enteral nutrition in infants born very preterm. Arch. Dis. Child Fetal Neonatal Ed. 109, 378–383 (2024).

    Article  PubMed  Google Scholar 

  14. Alshaikh, B. N. et al. Early exclusive enteral feeding in 30-33 weeks gestation infants: a randomized controlled trial. J. Perinatol. 2025 Feb https://doi.org/10.1038/s41372-025-02217-0.

  15. Miller, M., Vaidya, R., Rastogi, D., Bhutada, A. & Rastogi, S. From parenteral to enteral nutrition: a nutrition-based approach for evaluating postnatal growth failure in preterm infants. JPEN J. Parenter. Enter. Nutr. 38, 489–497 (2014).

    Article  Google Scholar 

  16. Thureen, P. J., Phillips, R. E., Baron, K. A., DeMarie, M. P. & Hay, W. W. Jr Direct measurement of the energy expenditure of physical activity in preterm infants. J. Appl Physiol. (1985) 85, 223–230 (1998).

    Article  PubMed  CAS  Google Scholar 

  17. Kashyap, S. et al. Effects of varying protein and energy intakes on growth and metabolic response in low birth weight infants. J. Pediatr. 108, 955–963 (1986).

    Article  PubMed  CAS  Google Scholar 

  18. Hamatschek, C. et al. Fat and Fat-Free Mass of Preterm and Term Infants from Birth to Six Months: A Review of Current Evidence. Nutrients 12, 288 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

W.W.H. Jr is the sole author of this Commentary.

Corresponding author

Correspondence to William W. Hay Jr..

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hay, W.W. Recommended nutrition for preterm infants—on track, but more research is needed. Pediatr Res 98, 365–367 (2025). https://doi.org/10.1038/s41390-025-04062-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41390-025-04062-5

Search

Quick links