The provision of optimal nutrition is critical in the management of preterm infants. Optimal nutrition improves survival while decreasing the potential for both short- and long-term morbidities. Current nutritional goals for the preterm infant are to provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same postmenstrual age while maintaining normal concentrations of nutrients in blood and other tissues.1,2 Considerable efforts have been made over the past decades to reduce the degree of extrauterine or postnatal growth faltering that occurs for very low birth weight (VLBW) infants, born weighing less than 1500 g, by the time of their hospital discharge. Although progress has been made, it was reported as late as 2013 that among preterm infants in the United States (birth weights between 500 and 1500 g), up to 50% of infants still demonstrated postnatal growth faltering and 25% demonstrated severe growth faltering.3 Much of the progress can likely be attributed to changes in practice that include introduction of parenteral nutrition within hours of birth, early initiation of enteral feedings in the first days after birth, adoption of standardized feeding guidelines, and improved nutrient fortification strategies.1,4,5 Postnatal growth faltering in preterm infants is largely attributable to the interaction of acute neonatal illnesses and nutritional practices, in which inadequate parenteral and enteral nutrition support lead to the development of energy, protein, and mineral deficits.5 Both adequate growth (including head growth) as well as improved nutritional support have been associated with improved long-term neurodevelopmental outcomes.6 Concerns have also been raised that the differences in early postnatal growth in preterm infants, including rate of catch-up growth, may predispose to later development of the metabolic syndrome. However, reviews have concluded that there is limited evidence that preterm birth, low birth weight, early postnatal growth failure, and subsequent catch-up growth have a negative effect on metabolic outcomes in preterm infants.7 These effects include increased adiposity, blood pressure, insulin resistance, and dyslipidemia. On balance, the evidence that postnatal catch-up growth of the VLBW infant after hospital discharge supports the beneficial effects of improved nutritional support on neurodevelopmental outcomes, is more convincing than long-term negative effects on metabolic outcomes.7