Pamela & all:
I must claim ignorance as to the capabilities of NICUs in Zimbabwe.  I would
be surprised if the populations of VLBW infants cared for there are the same
as in the USA.  It may be that you are dealing with the proven "survivors".
Although the USA has a poor overall infant mortality rate (for many reasons),
the birthweight-specific survival rate is one of the highest, if not the
highest in the world.

A baby going home at 1800 grams and 39 weeks is, by definition, undergrown.
The research clearly shows we (NICUs) are taking AGA (appropriate for
gestational age) infants at birth and turning most of them into SGA (small
for gestational age) infants by the time of discharge.  I have a hard time
believing that poor growth and lack of protein at this critical time is good,
or even acceptable.  The average gestational age at discharge from our NICU
is 35 weeks and weight around 2200gms (higher than it was even 10 years ago).
 Also, these infant are not just fatter, they are bigger.

We do have a standard to measure against - the intrauterine growth chart.  Is
this the correct one?  No-one knows. It is the only one at present.  There
are excellent estimates by various methods of the amount of protein a given
infant needs (the smaller and more immature - the higher the need).
Unfortunately human milk alone does not meet those needs.

Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital, and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA

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