Sooner Is Better: Early Human Milk Fortification for Hospitalized Preterm Infants <29 Weeks

Extremely preterm infants frequently experience growth impairment during the months-long NICU hospitalization. Clinicians have known for decades that “supply-side” interventions, such as milk fortification, improve short-term growth and reduce long-term consequences of undernutrition, but most prior large, randomized studies used now-outdated approaches, such as formula rather than human milk as the base diet, or powdered rather than concentrated liquid human milk fortifiers. With well-documented health benefits, human milk is the preferred diet for extremely preterm infants,¹ but nutrient deficits accumulate even with fortification. Perceived safety concerns of fortification may further limit adequate nutrient delivery, although not supported conclusively by evidence. In the early postnatal days, parenteral nutrition is the primary diet, but recent data suggest safety limitations to parenteral protein provision.² Thus, a pressing priority is to identify more effective early enteral nutrition strategies that minimize cumulative deficits while ensuring safety.