Preterm Infant (VLBW) Enteral Nutrition

Preterm Infant (VLBW) Enteral Nutrition

Welcome to the Very Low Birthweight Preterm Infant Enteral Nutrition Project
Implementation Tips: Preterm Infant Nutrition Care during the
Novel Coronavirus Covid-19 Pandemic (pdf)
Preterm birth is associated with increased risks for health, growth, and development complications. Adequate nutrition has the potential to minimize risk and perhaps improve health outcomes. The National Institutes for Health (NIH) and the Academy of Nutrition and Dietetics (Academy) initiated a two-phase project, known as the Pre-B Project,1,2 to address the lack of evidence-based nutrition practice guidelines based on systematic reviews for preterm infants. The first phase was coordinated by the NIH and involved a collaborative effort to identify research needs and potential topics for systematic reviews. The Academy coordinated the second phase with a multi-disciplinary expert panel that conducted a scoping review3, systematic reviews, and evidence-based practice recommendations.
VLBW Preterm Infant Enteral Nutrition Evidence-Based Nutrition Practice Guideline
The VLBW Preterm Infant Enteral Nutrition Practice Guideline is intended to inform the practice of registered dietitian nutritionists (RDNs) and physicians who provide individualized nutrition care for VLBW preterm infants. The evidence-based nutrition practice guideline includes recommendations on:
  • Protein Amount
  • Type of Fat
  • Human Milk Fortification
  • Formula Enrichment
  • Mother's Milk
  • Human Milk (Mother's and Donor)
  • Mother's Milk Supplementation

VLBW Preterm Infant Systematic Reviews

Using the results of the scoping review to develop the focus of the project, including the research questions, the expert panel focused on very low preterm term infants (≤1,500 grams birth weight). The following sub-topic areas were identified:

In preparation for phase II of the project, a rigorous scoping review was conducted in 2017 using the broad scope identified in phase I. The results of the scoping review Moloney L, Rozga M, Fenton, T 20193 were used to guide the focus of the systematic review.
  • Macronutrients
  • Human Milk vs. Formula

Key Findings:

  • Infants fed human milk should be enriched with multi-nutrient fortifiers
  • Infants should be fed with 3.5-4.0 g protein/kg/day
  • Evidence is lacking that supplementation with omega 3 fatty acid influences health outcomes
  • Infants fed ≥75% mothers’ own milk compared to formula is associated with lower incidence of retinopathy of prematurity
  • There is evidence of a positive dose response relationship between mothers’ own milk and development, a negative dose response between mothers’ own milk and sepsis
  • When mothers’ own milk is lacking infants should be provided with pasteurized donor milk

Use the left navigation to access the guideline recommendations and the supporting systematic review. Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the project, disclosures and project funding information. Expand the section below titled Resources and Articles to view articles published on this project. 


  1. Raiten DJ, Steiber AL, Carlson SE, et al 2016 Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants – the Pre-B Project. Am J Clin Nutr. 2016 Feb; 103(2):648S-678S.  PMID: 26791182 
  2. Raiten DJ, Steiber AL, Hand RK. Executive summary: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants – the Pre-B Project. Am J Clin Nutr. 2016 Feb; 103(2): 599S-605S.  PMID: 267911979 
  3. Moloney L, Rozga M, Fenton, T. Nutrition Assessment, Exposures, and Interventions for Very-Lo-Birth-Weight Preterm Infants: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet. 2019 Feb; 119(2): 323-339.  PMID: 29871835 
  • Resources and Articles

    The following resources were developed for implementation and dissemination of the VLBW Preterm Infant guideline:

    • Very Low Birthweight Preterm Infants: A 2020 Evidence Analysis Center Evidence-Based Nutrition Practice Guideline Fenton TR, Griffin IJ, Grow-Wargo, S, Taylor S, Rozga M, Moloney L. J Acad Nutr Diet 2022:122(1):182-206
    • Nutrition Assessment, Exposures, and Interventions for Very-Low-Birth-Weight Preterm Infants: An Evidence Analysis Center Scoping Review. Moloney L, Rozga M, Fenton TR. J Acad Nutr Diet 2019 Feb;119(2):323-339.
    • Effect of Enteral Protein Amount on Growth and Health Outcomes in Very-Low-Birth-Weight Preterm Infants: Phase II of the Pre-B Project and an Evidence Analysis Center Systematic Review. Fenton TR, Groh-Wargo S, Gura K, Martin CR, Tayor SN, Griffin IJ, Rozga M, Moloney L. J Acad Nutr Diet. Published: December 22, 2020. DOI:      
    • Very Low Birthweight Preterm Infants: A 2020 Evidence Analysis Center Evidence-Based Nutrition Practice Guideline. Fenton TR, Griffin IJ, Groh-Wargo S, et al. J Acad Nutr Diet. Published April 02, 2021.
    • Very Low Birthweight Preterm Infant Enteral Nutrition: Evidence-Based Nutrition Practice Guidelines Quick Reference Tool - a practical quick-reference pocket guide contains graded recommendations for VLBW preterm infants. Learn more ...   
  • Project Team and Disclosures (2020)

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Tanis Fenton, PhD, RD, FDC, Chair
      Professor, University of Calgary/Alberta Health Services, Calgary, AB, Canada
    • Sharon Groh-Wargo, PhD, RDN
      Professor, Nutrition and Pediatrics; Senior Nutritionist, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
    • Ian Griffin, MD, MB (as of 11/7/2018)
      Director of Clinical and Translational Research, Mid-Atlantic Neonatal Associates, Cedar Knolls, NJ, USA
    • Kathleen Gura, PharmD, BCNSP
      Manager, Pharmacy Clinical Research Programs, Boston Children’s Hospital, Boston, MA, USA
    • Camilia Martin, MD
      Associate Professor of Pediatrics, Harvard Medical Faculty Physicians, Beth Israel Deaconess Medical Center, Boston, MA, USA
    • Sarah N. Taylor, MD, MSCR
      Associate Professor, Yale School of Medicine, New Haven, CT, USA
    • Jacqueline Wessel, MEd, RDN (resigned 10/31/2018)
      Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Patient Advocate

    • Sandra A. Finestone, PsyD
      Executive Director, Association of Cancer Patient Educators, Irvine, CA, USA

    Project Leaders 

    • Lisa Moloney, MS, RDN, Project Manager
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Mary R. Rozga, PhD, RD, Lead Analyst
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Deepa Handu, PhD, RDN, Methodologist 
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA

    Evidence Analysts

    • Katherine Bower Kortsmit, PhD, MPH, RD
      ORISE Fellow, Center for Disease Control, Atlanta, GA, USA
    • Alison Brown, PhD, RD
      Boston Food Policy Council Member, Boston, MA, USA
    • Lyanne Chin, PhD candidate, RDN
      University of Wisconsin, Madison, WI, USA
    • Krista Engen, MS, RD, LDN
      Clinical Research Coordinator, Rush University Medical Center, Chicago, IL, USA
    • Laurie Inacio, MS, RD
      Consultant, Brunswick, ME, USA
    • Alexandra MacMillan Uribe, MS, RD
      Graduate Research Assistant, University of Wisconsin, Madison, WI, USA
    • Megan Piotrowski, MS, BSN, RN
      Student, Grosse Point Farms, MI USA
    • Jessica Soldavini, MPH, RD, LDN
      Graduate Research Assistant, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    • Helen D. Solomon, MBA, RD
      Retired, Wildwood, MO, USA

    Guideline Reviewers

    • Jennifer Bathgate, MPH, RD, CSP, LDN
      Clinical Dietitian, NICU, Lurie Children's Hospital, Chicago, IL, USA
    • Patricia J. Becker, MS, RDN, CSP, FAND
      Clinical Dietitian II, Dayto Children's Hospital, Dayton, OH, USA
    • Dena Goldberg, PhD, RDN
      Clinical Dietitian II, Carilion Clinic, Roanoke, VA, USA
    • Maggie Jerome, MS, RD, CNSC
      Predoctoral Fellow, University of Alabama at Birmingham, Birmingham, AL, USA
    • Andi M. Markell, RD, LD
      Medical Science Liaison Neonatal and Pediatric Nutrition, Prolacta Bioscience, Beaverton, OR, USA
    • Alyssa Norris, MS, RDN, LDN, CLC, CNSC
      Clinical Dietitian, St. Jude Children's Hospital, Memphis, TN, USA
    • Celina . Scala, MS, RD, CSPCC, LD, CNSC
      Neonatal Intensive Care Unit Dietitian, Akron Children's Hospital, Akron, OH, USA

    Financial Contributors

    • The Academy of Nutrition and Dietetics

    The views or interests of the funding body did not influence the development of the systematic review and guideline.

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have adverse impact on the content, but they are noted here to fully inform readers:

    • Fenton: Relationship with Innovate Calgary who assist with licensing of Fenton Preterm Growth Chart
    • Groh-Wargo: Co-Investigator, Site PI for infant formula clinical trials sponsored by Abbott Nutrition; Co-Investigator on NIH study “Wheezing in Black Infants Born Preterm: Impact of Vitamin D Supplementation; Academy’s Pediatric Care Manual; Abbott Nutrition sponsored speaker; meeting expenses paid by Abbott Nutrition
    • Gura: PI on project funded by Pfizer Global Health
    • Martin: Has consulted with Mead Johnson, Abbott, Nestle
    • Taylor: Institutional PI for a Baxter Pharmaceutical study; Institutional PI for Nutrinia study; served on NICU research advisory council for Medela; consult for Alcresta Therapeutcs and Mother’s Milk is Best; paid consult for Madela
    • Wessel: Compensation from Abbott Nutrition speaking engagement

    updated: February 2020