In the past, initiation of nutritional support of very low birth weight (VLBW) infants was delayed because of concerns about the safety of nutrient administration. This contributed to the impairment of neurocognitive development that these infants often display later in life. Today there is consensus that nutritional support of VLBW infants must begin immediately at birth. Because of immaturity of the gastrointestinal tract, nutritional support initially relies mainly on parenteral nutrition. Trophic feedings, preferably in the form of human milk, are provided as a stimulus for maturation of the gastrointestinal tract. Once maturation has occurred, parenteral nutrition is phased out. Although the objective of nutritional support is to meet the needs of VLBW infants at all times, nutrient deficits, albeit of a modest size, continue to be the rule. Continuing efforts are necessary to eliminate the remaining nutrient deficits.