Feeding Fortification in Preterm Infants

Preterm birth remains a significant global health challenge, often accompanied by complex nutritional needs that demand specialized care. Among the most critical interventions in neonatal nutrition is feeding fortification-a strategy designed to bridge the gap between the limited nutritional reserves of preterm infants and their accelerated growth and developmental demands. This narrative review explores the rationale, methods, and clinical implications of feeding fortification in preterm infants, emphasizing its role in optimizing outcomes during the neonatal period and beyond. Human milk, while ideal in many respects, often falls short of meeting the elevated protein, energy, calcium, and phosphorus requirements of preterm infants. Fortification, whether through human milk fortifiers or preterm formulas, provides essential nutrients that support catch-up growth, bone mineralization, and neurodevelopment. The timing, composition, and individualization of fortification strategies are crucial, as both under- and over- supplementation carry risks. Emerging evidence supports targeted fortification approaches, which tailor nutrient delivery based on the infant's biochemical markers and growth trajectory. This review also highlights the challenges in implementing fortification protocols, including variability in clinical guidelines, tolerance issues, and the need for ongoing monitoring. Furthermore, it underscores the importance of multidisciplinary collaboration among neonatologists, dietitians, and nursing staff to ensure safe and effective nutritional support. In conclusion, feeding fortification is not merely a nutritional adjunct but a cornerstone of care for preterm infants. Its thoughtful application can significantly influence short- and long-term health outcomes, reducing morbidity and enhancing developmental potential. Continued research and refinement of fortification practices are essential to meet the evolving needs of this vulnerable population.