Nutrition is more than simply nutrients. In recent years, we’ve started to recognise the importance of human milk oligosaccharides, growth factors, enzymes and microbes. Our brains are up to 20 times bigger than other mammals and 90% of final brain volume is acquired between 34 weeks gestation and two years of age. Neuronal processes are under the control of IGF-1, which is in turn impacted by nutrients, especially macronutrients. More than half of all energy expenditure in preterm babies is happening in the brain. Most of NICU care and monitoring is focused on cardiorespiratory management, but it’s very easy to fail to give babies adequate levels of macronutrients.