Beyond numbers: rethinking human milk fortification in preterm nutrition

As neonatal care continues to evolve, there is growing recognition of the need for individualized, functionally targeted nutrition in very preterm infants (VPIs). While human milk remains the gold standard, it frequently fails to meet the metabolic requirements of this high-risk group, requiring the adoption of fortification strategies. In this context, the study by Rasmussen et al., published in Pediatric Research, offers important insights into the metabolic implications of fortifying human milk with bovine colostrum (BC). The observed elevations in plasma concentrations of amino acids such as arginine, glutamine, and tyrosine suggest that BC may serve as a fortifier with potential clinical value. However, the disconnection between enhanced biochemical profiles and clear clinical benefit persists. Nutrient utilization depends not only on intake but also on inflammation, illness, organ immaturity, and individual metabolic variations. Infants’ anthropometrics, mainly head circumference and length, remain essential reference values, mirroring brain and lean mass development. A shift toward precision strategies incorporating biomarkers and long-term developmental follow-up is needed. This approach might hopefully be translated into sustained clinical benefit for VPIs. Impact: This commentary emphasizes the importance of evaluating neonatal nutrition through both surrogate biomarkers and functional clinical outcomes to better capture physiological relevance. It highlights the limitations of relying exclusively on compositional or biochemical analyses when assessing nutritional adequacy in preterm infants. The article contextualizes the findings of Rasmussen et al. within the metabolic complexity characteristic of preterm physiology. It underscores the role of clinical heterogeneity and variable nutrient utilization in shaping metabolic responses. The commentary advocates for integrated, technology-supported strategies to enable individualized, real-time precision nutrition in neonatal care.