Both postnatal nutritional deficit and postnatal growth restriction represent major issues in preterm neonates and have been associated with adverse long-term outcome. Optimisation of enteral nutrition without increasing the risk of necrotizing enterocolitis (NEC) has thus become a priority in preterm neonates. Due to their immaturity premature infants are frequently started on parenteral nutrition and then switched with different times and methods to enteral nutrition. Most recent ESPGHAN recommendations for enteral nutrition suggest for an average preterm infant a pro kg daily supply of 110–135 kcal, 3.5–4 g proteins, and 4.8–6.6 g lipids, inclusive of medium chain triglycerides if added, and adequate amounts of linoleic and alpha-linolenic acids, arachidonic and docosahexaenoic acids. The use of human milk for preterm infants has increased over the past decade reflecting an improved awareness of the benefits of human milk. A number of breast milk components have been credited with anti-inflammatory properties reducing clinical morbidities such as NEC and sepsis in the preterm infant. However, as breastfeeding is quite difficult for premature infants, a comprehensive approach to standardising preterm infant nutrition is essential to optimise the collection, storage, fortification and delivery of human milk to preterm neonates. Many questions remain unresolved such as the definition of optimal postnatal growth velocity, the most effective way of transition from parenteral to enteral nutrition and the role of compounds such as probiotics and prebiotics. As a matter of facts, there is great heterogeneity in nutrition practices among neonatal units, with frequent discrepancies.