   Premature infants have greater nutritional needs
                           The nutrient needs are inherently high at this stage of development to 
                            match the high rates of nutrient deposition achieved by infants in utero 
                            They often have medical conditions that increase their metabolic energy 
                            requirements:
                                   o  including hypotension
                                   o  hypoxia
                                   o  acidosis
                                   o  infection
                                   o Surgery
                         
                           Physiologic immaturity of the gastrointestinal tract, including :
                                   o Decreased gastrointestinal motility 
                                   o  Reduced intestinal enzyme activity 
                                   o  Therapies such as corticosteroids
                              Despite intensive nutritional strategies for premature infants, growth 
                               failure remains a major problem. 
                              Intensive feeding strategies must be balanced with potential risks.
                                o  As an example, while early initiation of enteral feedings has been shown to 
                                    benefit premature infants, very rapid advancements of enteral feedings may 
                                    result in feeding intolerance or necrotizing enterocolitis (NEC) 
                              It is important to choose feeding practices associated with improved 
                               outcomes for premature infants,such as the use of human milk rather 
                               than formula.
       Feeding intolerance
             Feeding intolerance
            Difficulty tolerating enteral feedings is a major problem for 
              premature infants, especially in :
                
                   Those with gestational age below 28 weeks
                
                   Those who require positive pressure support
                
                   Those who have positive blood cultures 
                            :Factors that affect feeding tolerance include
                                         Intestinal motility
                                         Gastric emptying
                                         Stool output
                                         Digestive enzymes
                                         Type of feeds (formula or human milk)
                                         Rapidity of feeding
                                         Volume of feeding
                                         Concentration of milk
                                          Concomitant medications
                                         Medical conditions