Growth and nutrition in early life for very preterm infants - Implications for neonatal lung health

Very preterm birth (< 32 weeks' gestation) disrupts a critical window of lung development, placing infants at substantial risk of bronchopulmonary dysplasia (BPD) and long-term respiratory morbidity. Nutrition is increasingly recognised as a modifiable determinant of neonatal lung health across three distinct but interconnected phases: (1) During the antenatal period, maternal macronutrient and micronutrient status, including vitamin D, omega-3 fatty acids, and folate, shapes placental function, fetal lung growth, and surfactant biosynthesis. Fetal growth restriction, a consequence of placental insufficiency, profoundly impairs pulmonary vascular and alveolar development. (2) In the neonatal intensive care unit, early aggressive parenteral nutrition followed by optimised enteral feeding with human milk reduces BPD risk, while targeted macronutrient delivery and specific micronutrient supplementation support ongoing alveolarisation. (3) After hospital discharge, catch-up growth and sustained human milk feeding are associated with improved lung function, reduced respiratory hospitalisation, and lower rates of recurrent wheeze. This review synthesises current evidence and translates it into practical guidance across all three phases, to optimise nutritional strategies for vulnerable infants.