Available nutritional fatty acid guidelines are not evidence-based and neither optimal composition nor amounts needed to meet the demands of these immature infants are known. What is known is that most infants born extremely preterm develop a large energy deficit resulting in poor neonatal growth. Many experience moderate hyperglycemia associated with lipid infusion. Hyperglycemia is a strong risk factor for preterm mortality as well as for ROP and other disorders of prematurity. With commonly used lipid solutions, preterm new-borns experience a rapid decline in blood fatty acid proportions of the long chain polyunsaturated fatty acids (LCPUFA), Arachidonic acid (AA) and DHA, as compared to the intra-uterine situation.