Fortification of human milk for feeding preterm infants: What is the ideal strategy?

Promoting optimal growth in preterm infants is of paramount importance. Multiple reports have associated better growth during their Neonatal Intensive Care Unit (NICU) stay with improved neurodevelopmental outcome and a lesser risk of certain morbidities. Nowadays, most preterm infants receive human milk (HM) feedings, either mother's own or donor milk. Widespread use of HM to feed preterm infants has contributed to a decrease in complications like necrotizing enterocolitis. This notwithstanding, HM often does not provide sufficient protein and other nutrients to promote adequate growth in these infants and, therefore, must be fortified with specially designed human milk fortifiers of human or bovine origin. These provide added amounts of protein, minerals like sodium, calcium, and phosphorus as well as vitamins and other micronutrients. Which fortification strategy, i.e. type of fortifier, timing of fortification, must be used to promote optimal growth and neurodevelopment is still a matter of debate. The following articles by the well-recognized experts in neonatal nutrition, Drs. Amy Hair and Brenda Poindexter, will describe alternate strategies to fortify HM and their potential benefits, and are a reflection of the scholarly discussions held during the 2025 Neonatal Insights: Best Evidence and Practice in Clinical Neonatology Conference.