To evaluate the benefits (growth and feeding tolerance) and risks (NEC prevalence) of EES we randomized 313 AGA or SGA VLBW (BW ≤1500 g) divided into “healthy” or “sick” according to a predefined criteria from 1993-95. Congenital malformations, metabolic disease, and infants with imminent risk of death were excluded. EES received 25 ml/kg/d of breast milk or premature formula enterally, while controls were given only parenteral fluids and nutrition. For “healthy”, EES was started at 12 to 24 hours and continued for 48 hrs; for “sick” EES started at 36 to 48 hrs and continued for 6 - 8 days of life. After this period, feedings were advanced for both groups at a rate of ≤20 ml/kg/day fortifying breast milk after 100 ml/kg/day was reached. Results: 161 patients received EES and 152 were controls. Groups were similar in B.W. (1129 and 1095 g), gestational age (29.9 and 29.5 wks),% of healthy or sick infants, prenatal steroids or TrH, umbilical catheters, RDS, PDA, sepsis, use of breast milk or formula. EES induced differences were observed in weight gain from day 10 to 18, max delta was 54 g. Feeding tolerance was better in healthy EES group, hours of npo were lower relative to controls (32 vs 50 hrs). Hyperglicemia was more severe in controls relative to EES (242 vs 350 mg/dl). Number of days to recover birth weight, weight at 60 days, days to reach 2000 g were similar. Failure to complete EES occurred in 31 patients. Prevalence of NEC (8.7vs8.6%), sepsis and overall mortality until discharge (11.8 vs 11.8%) were similar. We conclude that under ordinary clinical practice EES is beneficial for VLBW in terms of early weight gain, feeding tolerance and hyperglycemia. Prevalence of NEC and sepsis were not affected. Funded in part by Mead Johnson Bristol Myers Nutrition Research Program.