Introduction: Very low birth weight (VLBW) is a term used to describe babies who are born weighing less than1.5 kilograms. The main cause of a baby having VLBW is being born too early and this is called preterm or premature birth. Premature means a baby is born before 37 weeks of pregnancy. Another cause of very low birth weight is when a baby does not grow well during pregnancy and this is called intrauterine growth restriction (IUGR), it may happen because of problems with the placenta, the mother's health, or birth defects. Objective: This study aimed to assess the impact of intrauterine growth restriction on gastrointestinal tract tolerance to nutrition in very low birth weight neonates. Patients and Methods: This study was applied on 48 very low birth weight neonates who were divided into two equal groups (AGA and SGA groups). They were admitted to NICU in Zagazig University Children Hospital, during the period from March 2020 to September 2020. Results:Incidence rate of feeding intolerance was nearly equal in SGA and AGA very low birth weight neonates, but incidence of feeding intolerance signs were different between them. Conclusion: Intra-uterine growth restricted Very low birth weight newborns were susceptible to intrauterine deprivation of nutrients to gastrointestinal tract due to placental insufficiency resulting in prematurity and immaturity of gastrointestinal tract function resulting in poor tolerability of GIT to enteral feeding. Trophic feeding, which was early initiation of enteral feeding along with parenteral nutrition seemed to improve feeding tolerance, decrease duration of parenteral nutrition, insure more mature intestinal motility patterns and increase growth rate.