Exclusive enteral nutrition in preterm infants: How early is too early?

With the growing availability of maternal and donor milk, neonatal feeding practices are undergoing significant transformation. Increasingly, neonatal units are prioritizing exclusive enteral nutrition soon after birth, a shift that represents a substantial advance in neonatal care. However, critical questions remain regarding the implementation, safety, and long-term outcomes of this approach. This review consolidates the evidence supporting early and exclusive enteral nutrition, exploring its potential to redefine neonatal care practices, particularly in high-resource settings. By examining challenges such as variability in practices, resource constraints, and clinical decision-making during acute illness, this discussion aims to provide a roadmap for integrating these practices into routine care and advancing outcomes for preterm and vulnerable infants.