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Macrosomic infants (birth weight >4000 g) show increased risk for shoulder dystocia and associated injuries, hypoglycemia and respiratory distress. Higher risk is directly related to neonatal birth weight. High birth weight is also associated with increased risk of developing metabolic syndrome later in life. However the relation between birth weight and later-life metabolic syndrome in not linear, but "U" shaped.

In recent years, improvements in obstetrical and neonatal care have significantly improved survival in preterm and, particularily, the very low birth weight infant. Several studies stress the importance of timely and adequate nutrition in these high-risk infants on a short- and long-term. Presently, there is little consensus among the neonatologists concerning the optimal way to initiate, advance or maintain enteral feeding in preterm Infants. The preferred food for premature infants is fortified milk from the infant's own mother or,alternatively, formula designed for premature infants. The recent guidelines proposed by ESPGHAN Committee on Nutrition provide minimal and maximal levels of intake for individual macro- and micro-nutrients.

The preterm newborn infant for his very high growth rate is especially vulnerable to any deficiency or excess of the nutritional intake. Moreover he differs from the older infant because of the immaturity of many biological function. Such immaturity is temporary in the term newborn, while lasts longer in the preterm newborn infant. In this paper needs for energy, proteins, lipids, carbohydrates and minerals in the preterm newborn are reported. They are based on metabolic balance studies carried out in preterm newborn infants fed either human milk or different formulas. The own mother fresh milk, supplemented with phosphorus, appears to be the best feeding for the preterm infant. Formulas conveniently adapted in carbohydrates, proteins, lipids and minerals content may be used as reasonable substitutes. On the contrary the pooled pasteurized human milk is not advisable.

During a five years period 8 newborns on 2035 admissions developed septic arthritis representing a very low incidence of 4%. Umbilical catheters were used in 3 patients. Staphylococcus aureus was the most frequent etiologic agent and in 6/8 cases blood cultures were positive for the same pathogen agent. Because of the paucity of clinical signs in the first period in the sick neonate, detection of the disorder by the radiologist assumes great importance in the neonatal intensive care unit, as early recognition and therapy may prevent residual deformity.

The etiopathogenesis and the clinical implications of fat malabsorption in preterm infants are reviewed. Low pancreatic lipase activity and impaired solubilization of lipids due to low intraluminal concentration of bile salts appear to be the main factors of the inadequate lipid absorption. The compensatory role of intragastric lipolysis could be important. Currently available informations suggest that, chylomicron formation and transport of lipids are not limiting steps, but the efficiency of these processes in neonates needs further investigations. Due to its bile-stimulated lipase activity, non-heat-treated human milk used at least in part, appears to be the most effective method to improve fat absorption in the preterm infant.

Protein, fat and carbohydrate absorption in preterm infants fed on human milk or formulae are reviewed. Even in the most premature infants absorption of protein is satisfactory. Nitrogen net absorption is about 85-90% of intake and results slightly lower with human milk than with formulae. The lower apparent digestibility of human milk is probably due to the poorly degraded IgA immunoglobulins and the rapid transit time. Lactose is well tolerated by the preterm infants despite the low lactase activity at birth. Glucose polymers, which have a low osmotic activity and are suitable for increasing carbohydrate intake of formulae, are well absorbed probably for the activity of salivary amylase and brush border glucoamylase, which have been shown to be well developed at birth. Premature infants absorb fat poorly. This malabsorption that increases with the lowering of gestational age is due to low pancreatic lipase activity and to low intraluminal concentration of bile salts. Due to its bile stimulated lipase activity, non-heat-treated human milk used at least in part is an effective method to improve fat absorption in preterm infants. Faecal energy determined using a calorimetric bomb appears to be a simple and an accurate method to predict faecal fat and avoiding expensive and cumbersome analysis.