177 General discussion 8 such as enteral IGF-I supplementation, have failed to yield the expected results in preterm infants.(38) Future research should aim to explore how more IGF-I bioactivity can be retained when IGF-I is supplemented enterally. Furthermore, it would be of interest to investigate whether adapting nutrient intake to IGF-I levels improves health outcomes. At the theoretical threshold value of IGF-I between 30 and 32 weeks postmenstrual age, human milk fortification could be limited to prevent rapid growth and possible associated adverse events. On the other hand, a phase 2 trial showed that continuous intravenous supplementation of IGF-I reduces the occurrence of major comorbidities such as BPD. (27) With these promising results, it is important for future research to aim to investigate the effect of IGF-I administration on both growth and body composition, in addition to the occurrence of morbidities. Lastly, cross-sectional longitudinal studies are warranted to investigate the best method for the follow-up of body composition in preterm infants.
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