Bone disease with significantly reduced bone mineralization is common in preterm infants, and associated with later linear growth stunting at 18 months of age. Dietary insufficiency of calcium and phosphorus is thought to be the principal aetiological factor. We studied 54 children at mean age 5 years who were born preterm and had participated in a prospective multicentre study of effects of early diet on later growth and development. Diets compared were banked donor breast milk and preterm formula fed as a supplement to mother's own milk. Increasing human milk intake was strongly positively associated with later bone mineral content. Children fed predominantly human milk had greater bone mineral content than children of similar size born at term. These data suggest that the early nutritional environment of the preterm infant could play an important role in determining later skeletal growth and mineralization.

The sick preterm infant has special nutritional needs, and the provision of appropriate nutrition is now recognised as an important part of the increasingly intensive management of this population. "Optimal" nutrition is difficult to define for an individual infant, but prospective randomised studies have shown that the early diet given to preterm infants can have a major impact on their neurological development and growth, with the best outcomes for those receiving either a preterm formula or maternal milk fortified with a range of nutrients. In contrast, diets suitable for term infants do not meet the needs of small preterm infants, either in the short or longer term, and should not be used. This article reviews the nutritional needs of the preterm infant and outlines the strategies commonly used in this area of neonatal intensive care.