Fortifying the future: updates in knowledge and practice principles of human milk fortification

Human milk (HM) is the preferred source of nutrition for preterm infants given its well-established clinical benefits. However, unfortified HM does not provide sufficient protein, energy, and micronutrients to meet the metabolic demands of very low birth weight infants, making fortification necessary to support optimal growth and reduce the risk of adverse outcomes. This review examines contemporary strategies in human milk fortification, including the timing of initiation, differences between human milk-derived and bovine milk-derived fortifiers, with particular attention to the micronutrients essential for preterm infant growth. Current evidence supports the routine use of fortification to improve growth, and earlier initiation of fortification appears safe in stable preterm infants. However, available data do not consistently demonstrate superiority of one type of fortifier across all clinical outcomes, underscoring the importance of context-specific decision making. Increasingly, individualized approaches such as adjustable and targeted fortification, guided by human milk analysis, are being explored to address variability in milk composition and infant nutritional requirements. Future strategies will likely emphasize precision nutrition while preserving the biologic integrity of HM, ensuring that growth optimization and intestinal protection remain aligned rather than competing priorities.