A syndrome in very low birth weight premature infants weighing less than 1500 g is evidenced by developmental nutritional rickets and fractures at 75 days of age. In a review conducted over 42 months, 247 very low birth weight cases were identified. Rickets was diagnosed in 96 (39%) infants whose mean age was 50 days and fractures were diagnosed in 26 (10.5%) infants whose mean age was 75 days. These 26 infants experienced 98 fractures: 10 humerus, 13 radius, 8 ulna, 4 metacarpal, 3 clavicle, 54 ribs, 5 femur, and 1 fibula. Risk factors included hepatobiliary disease, total parenteral nutrition, diuretic therapy, physical therapy with passive motion, and chest percussion therapy. With early recognition, metabolic therapy and splinting, not casting, are appropriate treatments.