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This retrospective data analysis demonstrated inadequate provision of parenteral nutrition in our NICU, which was often not in line with current German guidelines. This was associated with inadequate growth in our cohort, most notably during the first 3 weeks of life; however, implementation of current guidelines is impeded by metabolic disturbances in this cohort, most notably in ELBW neonates. Whether adherence to published guidelines will result in better early ex utero growth, and whether this normalized growth pattern will translate into better long-term outcome on a metabolic and neurological level, remains unclear.

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Necrotizing enterocolitis has also been one of the most difficult disorders to eradicate and its pathogenesis, for example occurrence of infectious-like outbreaks, remains as elusive as optimal strategies for prevention and treatment, despite decades of research [1]. While data from RCTs and meta-analyses indicate that some factors may positively influence the incidence of NEC