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Human milk fortification in preterm infants: Navigating evidence, practice, and controversy
Amy B Hair1, Brenda B Poindexter2
1Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, One Baylor Plaza, Houston, TX, 77030, USA.
Seminars in Fetal & Neonatal Medicine
|April 19, 2026
Summary
Fortifying human milk is essential for preterm infants. Research is needed on different fortifier types for both maternal breast milk and donor breast milk to ensure optimal infant growth.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Human Milk Research
Background:
- Human milk is the ideal nutrition for preterm infants, offering crucial immunologic and bioactive benefits.
- Preterm infants have higher metabolic and nutrient needs than term infants, necessitating breast milk fortification.
- Current fortification strategies require evaluation for optimal outcomes in premature infants.
Purpose of the Study:
- To review current evidence on the rationale, composition, and outcomes of different breast milk fortification approaches for preterm infants.
- To synthesize findings from the 2025 Neonatal Insights Conference, including expert discussions and audience questions.
- To identify research gaps and future directions in preterm infant nutrition and fortification.
Main Methods:
- This study is a narrative review synthesizing existing literature and conference discussions.
- It evaluates randomized controlled trials (RCTs) on fortifier types, though acknowledges limitations in study size and MBM usage.
- The review considers evidence related to both maternal breast milk (MBM) and donor breast milk (DBM) fortification.
Main Results:
- Limited RCTs exist for evaluating fortifier types, with many studies focusing on MBM.
- There is a need for more research comparing fortifier efficacy in infants receiving MBM versus primarily DBM.
- Optimal growth and development in preterm infants depend on individualized nutrition and breastfeeding support.
Conclusions:
- Fortification of both MBM and DBM is crucial for meeting the nutritional demands of preterm infants.
- Future research should prioritize RCTs comparing fortifier types in diverse feeding scenarios (MBM vs. DBM).
- Personalized nutrition planning and robust maternal breastfeeding support are key to optimizing preterm infant outcomes.
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