Nutrition of premature and critically ill neonates.

Advances in mechanical ventilation, the use of pulmonary surfactants, improved pharmacological management of expectant mothers and preterm infants and greater confidence in our overall intensive care techniques have resulted in a marked increase in the number of very immature infants who survive. The same ethical controversies of 20 years ago surrounding whether or not to resuscitate prematures of 26–28 weeks gestation are now focused on 22–24 weeks. Those involved with the care of these survivors are faced with a constellation of problems that include prevention of morbidity and fulfillment of genetic potential. Nutrition is becoming a key factor not only for the growth of these infants during their neonatal intensive care unit (NICU) stay, but also for prevention of morbidity and enhancement of their life-long well being. The major goal of this review is to provide the reader with an overview of a few recent advances in nutrition that can be applied in the daily care of these patients. In addition, a few emerging concepts about conditionally essential amino acids, long-chain polyunsaturated fatty acids (LC-PUFAs) and probiotics are presented that are likely to become important modalities in the future care of these infants.