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The long-term developmental impact of nutrition on the preterm newborn has recently been shown to be of even greater importance than previously recognized. Very immature or ill infants are challenged by the need for a high caloric intake, but are unable to tolerate large fluid volumes. These patients may require enhanced-calorie formulas to achieve the desired growth goals. Formula enhancement has traditionally been performed by uniquely developed recipes of base formula concentration with the addition of powdered formula or single components such as medium-chain triglycerides oil, protein, or polycose. These mixtures have been largely unstudied for bioavailability, long-term outcomes, and tolerance. Deviation from recommended protein, fat, carbohydrate, mineral, and vitamin delivery limits may impair growth or lead to undesirable side effects. The practitioner must have an understanding of when and how to use an enhanced formula and the important monitoring and assessment needs of the patient receiving enhanced-calorie formula.

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