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The interrelation of malnutrition and respiratory morbidity in sick neonates with respiratory disorders has been increasingly identified over the past years. Improved respiratory care has allowed survival of more premature neonates who require cautious nutritional management while better nutritional support has been associated with more favourable clinical outcomes of specific respiratory disorders. Undernutrition plays a well-established role in respiratory disease both in the acute as well as in the later phase which are characterised by increased energy and nutrient requirements. The population of premature neonates who most commonly suffer from respiratory disorders have distinct physiological characteristics which make them vulnerable to nutritional deficits with detrimental short and long term effects. The widely accepted extrauterine nutritional goal of meeting the intrauterine growth rate is rarely met in the neonatal intensive care unit which constitutes a demanding and stressful environment. Sick neonates needing ventilatory support often have to meet increased nutritional demands. Meeting these needs represents a unique challenge for the neonatologist and the clinical dietician. Enteral nutrition should be initiated as early as clinically allowed preferably with maternal breast milk while parenteral nutrition should be provided with a view to meet the infants nutritional needs during the transition period. Although various hypotheses have been formulated linking specific nutrients supplementation with improved respiratory outcomes, such a relationship cannot overall be supported by the currently existing evidence.