Low total protein (TP) (serum TP <5.0g/dl) is often observed in infants with BW ≤1250g, especially after transition from total parenteral (TPN: with multivitamins and trace minerals at birth) to enteral nutrition (EN) with recommended macro nutrients (fortified breast milk or special care formula at≈ 120 cals/kg). Methods: We studied the micronutrient profile by serial 1-2 week serum assays of TP, retinol (ROH), tocopherol (E), retinal palmitate (R-Pal) and zinc (Zn) in 76 babies of which 17 were excluded for death, early transfers for surgery and need for high dose E Rx for prethreshold ROP. 59 infants were followed to about 38 weeks PCA, 57 of whom had values for all analytes after EN. Recommended EN supplements of micronutrients were given. Incidence of Stage 1 NEC was 15%, that of surgical NEC was 1.7% and feeding intolerance was noted in 30% of the babies.Results: 51/57 infants had low TP after EN; 42/57 had Zn ≤80 mcg/dl (74%) and 13/42 had E malabsorption (31%) defined as requirement for E supplements of 75-400u/day to maintain serum E above 1.0mg/dl. Very low TP(≤ 4.5g/dl) occurred in 44/57 infants (77%) of whom 25 (57%) had low Zn and 10/25 (40%) had E malabsorption. Decline in TP was usually associated with decline in Zn with mean nadirs at 56.1±24.4 and 68.1±32.4 days, respectively. Diuretic use was significantly associated with low Zn (in 93% of babies with diuretics vs 65.6% without; p<0.02). Malabsorption of vitamin E after EN also occurs in a significant subgroup with low Zn and very low TP(38%). Data related to Vitamin A nutrition (ROH and R-Pal) are yet to be analyzed. Conclusions: Interaction of micronutrients are influenced by rapid growth, decreased intake, history of morbidities and diuretic use. Very low TP (optimally serum albumin) values may serve as a serial screening index for Zn related E-malabsorption. Table

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