Meeting the challenge of providing neonatal nutritional care to very or extremely low birth weight infants in low-resource settings.

Most infant deaths (99%) occur in developing countries. The 14.9 million infants born prematurely (>11% of all live births) carry a particularly high mortality risk. This chapter discusses strategies to improve neonatal outcome under resource-restricted conditions, with a focus on nutritional interventions. Evidence-based interventions begin before conception with strategies to prevent and treat malnutrition among women of reproductive age, and micronutrient supplementation in pregnancy. As an example, a practically feasibly strategy of feeding very low birth weight infants in South Africa is presented. The use of parenteral nutrition can be limited by feasibility and affordability, but intravenous glucose and electrolytes should generally be provided after birth. Emphasis is put on the use of expressed own mother's milk without or with pasteurization from women without or with HIV infection, respectively, which is complemented by the use of pasteurized donor milk. If human milk fortifiers are not available, calcium and phosphate should be added, and high total daily feed volumes should be strived for, e.g. by frequent feedings. With restricted resources, human milk fortifiers or preterm formula can be used for high-risk groups such as infants with poor growth. Kangaroo mother care and breastfeeding should be actively encouraged.