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Objective:To determine if enteral protein and energy supplementation would significantly improve weight gain as compared with energy supplementation alone in 1250 g infants.Study Design:Inclusion criteria were birth weight (BW) 1250 g, postnatal age 14 days, diet of 75% enteral nutrition (fortified human milk or formula) and either failure to regain BW or weight gain<15 g kg-1 per days. Infants were randomized to a multinutrient supplement that provided increased protein and energy (P/E) intake or energy alone (medium chain triglyceride oil, MCT). Growth rates were compared at the end of the 4-week study period.Result:Of 30 eligible infants, 23 were enrolled, 12 received MCT (BW=862±252 g, mean±s.d.) and 11 received P/E (BW=879±241 g). Significantly higher protein intake (P/E=3.5±0.3 g kg-1 per day, MCT=3.0±0.5 g kg-1 per day) and better growth (P/E=17.0±2.4 g kg-1 per day, MCT=11.5±4.8 g kg-1 per day) were observed in the P/E group.Conclusion:These data are consistent with the importance of providing additional daily protein intake to achieve increased postnatal growth in very low birth weight infants experiencing slow growth. [ABSTRACT FROM AUTHOR]