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The etiopathogenesis and the clinical implications of fat malabsorption in preterm infants are reviewed. Low pancreatic lipase activity and impaired solubilization of lipids due to low intraluminal concentration of bile salts appear to be the main factors of the inadequate lipid absorption. The compensatory role of intragastric lipolysis could be important. Currently available informations suggest that, chylomicron formation and transport of lipids are not limiting steps, but the efficiency of these processes in neonates needs further investigations. Due to its bile-stimulated lipase activity, non-heat-treated human milk used at least in part, appears to be the most effective method to improve fat absorption in the preterm infant.

The preterm newborn infant for his very high growth rate is especially vulnerable to any deficiency or excess of the nutritional intake. Moreover he differs from the older infant because of the immaturity of many biological function. Such immaturity is temporary in the term newborn, while lasts longer in the preterm newborn infant. In this paper needs for energy, proteins, lipids, carbohydrates and minerals in the preterm newborn are reported. They are based on metabolic balance studies carried out in preterm newborn infants fed either human milk or different formulas. The own mother fresh milk, supplemented with phosphorus, appears to be the best feeding for the preterm infant. Formulas conveniently adapted in carbohydrates, proteins, lipids and minerals content may be used as reasonable substitutes. On the contrary the pooled pasteurized human milk is not advisable.