Human milk provides the optimal nutrition for term infants. Human milk is also
recommended for preterm infants, but does not alone provide optimal nutrition. The growth
and neurodevelopmental needs of the evolutionarily new population of very premature
infants are best met by appropriate fortification of human milk. To explore the role of
human milk in the care of premature infants, it is appropriate to begin with a comparison of
amniotic fluid (the optimal beverage of the fetus), milk from mothers delivering preterm,
and milk from mothers delivering at term. We will then consider the benefits and challenges
of providing human milk to premature infants, approaches to human milk fortification, the
advantages and challenges of donor human milk products, and finally some practical
approaches to increasing human milk consumption in premature infants.
In the United States, approximately 12% of infants are born preterm (prior to 37 weeks
gestation).1 This is a very heterogeneous population with widely diverse nutritional
requirements and highly different stages of immunocompetence. A 2.5 kg neonate born at 34