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.