Human Milk Fortification in Preterm Infants: Clinical Management, Practical Considerations, and Current Approaches

Objective: Human milk is the recommended primary source of nutrition for preterm infants; however, it is often insufficient to meet their increased nutritional requirements. This review aims to evaluate current evidence on human milk fortification in preterm infants, with a particular focus on clinical management, implementation processes, and safety considerations. Methods: A narrative review was conducted based on current literature, international guidelines, and recent studies addressing human milk fortification, including its timing, methods, types of fortifiers, and practical applications in neonatal intensive care units. Results: Human milk fortification is essential for supporting optimal growth and neurodevelopment in preterm infants. Both standard and individualized fortification strategies are widely used; however, no clear superiority has been established. The effectiveness of fortification depends not only on nutrient composition but also on appropriate preparation, storage, and administration processes. Factors such as increased osmolality, contamination risk, and feeding intolerance may influence clinical outcomes. Emerging evidence also highlights the potential role of chronobiological approaches and feeding timing in improving clinical outcomes. Conclusion: Human milk fortification in preterm infants should be considered a dynamic clinical process rather than a simple nutritional intervention. Individualized strategies, standardized implementation procedures, and careful monitoring are essential to ensure safety and optimize outcomes. Further research is needed to determine optimal fortification strategies and to clarify the clinical impact of emerging approaches such as chrononutrition.