Feeding and nutrition protocols will be standardized among participating institutions to minimize the confounding effects of diverse practices. A standard feeding protocol may be started at 24-48 hours of life at a volume of 10 ml/kg/day if the patient is hemodynamically stable, defined as having a stable blood pressure. The two milliliters of breast milk or premature infant formula will be subtracted from this total daily volume. Feedings will be advanced slowly at a volume between 10 and 20 ml/kg/day depending on tolerance.84 Umbilical lines may be removed once feeds are increased above 20 ml/kg/day. Parenteral nutrition will be started on the second day of life according to a standardized protocol. MCT oil (2 kcal/30ml) will be used as a dietary supplement to increases the energy content of breast milk or formula when needed. Human milk fortifiers may be started once full enteral feeds have been tolerated. Feedings will be discontinued and an abdominal radiograph taken if there are any signs of feeding intolerance (recurrent emesis, gastric aspirate > 50% of previous feeding with abdominal distension or the presence of macroscopic blood in stools). In situations where feeds have been temporarily discontinued, patients may re-enter the study at the initiation of feeds. Patients who develop NEC may continue in the study if they are able to resume feeds after treatment. Inotropic support, if being weaned, is not a contraindication to begin or continue the protocol. Administration of probiotic will end at discharge, but the infant's status will continue to be monitored until 6 months post-discharge. Patient's participation in the study will end at 6 months post-discharge, or upon the death of the patient.