Objective: To assess the safety and efficacy of early amino acid (AA) administration in preterm neonates <28 weeks gestational age.Study design: Prospective data collection for 1 year for the late AA group (AA started at 12-30 h) and for another year with practice change to early AA administration (immediately after stabilization).Results: Time of initiation of AA differed (early group 4±3 h vs late group 20±6 h; P<0.001). There were no statistically significant differences in the incidence of clinically significant metabolic acidosis. Blood urea at 24 h was higher in the early AA group. No significant differences in growth rate or neonatal outcomes were identified. Days to regain birth weight and sepsis were lower in the early AA group.Conclusions: Early AA administration was not associated with any clinically significant adverse effects; it was associated with reduction in the incidence of sepsis and marginally effective in reducing time to regain birth weight.