Advances in Pre‑Term Nutrition: Optimizing growth and outcomes for the smallest patients

In this episode of Milestones in Pediatric Nutrition, Professor Andrew Prentice speaks with Professor Josef Neu from the University of Florida about advances in preterm infant nutrition. Professor Neu traces the field's evolution from the late 1800s, when incubators adapted from poultry technology reduced mortality by half, through critical developments including infection control, mechanical ventilation, and surfactant therapy. Modern neonatal care has achieved remarkable outcomes, with survival rates exceeding 50% at 22 weeks gestation in some centers. The discussion highlights the unique nutritional demands of premature infants, requiring approximately 120 calories per kilogram daily, alongside 3-4 grams of protein per kilogram to support rapid growth and neurodevelopment. Professor Neu addresses historical controversies, including delayed enteral feeding practices, and emphasizes the importance of early gastrointestinal tract stimulation for mucosal immunity and barrier function. Current best practices favor mother's own milk with fortification when necessary, supported by evidence-based guidelines from pediatric societies. Professor Neu also discusses precision nutrition approaches utilizing artificial intelligence, machine learning clustering, and digital twin technologies to better individualize nutrition by gestational age, sex, and early-life exposures.