Providing nutritional support to the preterm infant in the neonatal ICU has proved challenging despite improved survival rates among this vulnerable population. Premature infants are at higher risk for medical complications compared to term infants given their decreased birth weight and immature development. Human milk is associated with better health outcomes related to immune modulation, neurological development, and gastrointestinal function compared to preterm formula. However, extra-uterine growth failure still persists with the use of human milk. Human milk fortifiers are available to increase the macronutrient and micronutrient content of breastmilk to meet the increased needs of premature infants born weighing less than 1500g. Although adequate nutritient delivery can improve growth velocity, the most appropriate nutrition regimen to fortify human milk is not known. This review summarizes the benefits and limitations of available human milk fortification strategies as seen during my advanced clinical rotation in the Level III neonatal ICU at Children’s National Medical Center in Washington, D.C.