This learning activity equips nurses with evidence-based strategies for human milk fortification in preterm neonates, addressing the critical nutritional needs of infants weighing less than 1,000 grams who require 3.5-4.5 grams of protein per kilogram daily. Nurses will learn to compare fortification products, calculate protein requirements, adjust fortification based on growth parameters and blood urea nitrogen levels, and recognize clinical red flags including inadequate weight gain, metabolic acidosis, and elevated alkaline phosphatase. The content examines current evidence on fortification timing, discusses emerging research on acute kidney injury risks, and provides communication strategies for family conversations about feeding options. By emphasizing individualized assessment over rigid protocols and integrating practical calculations with clinical decision-making, this learning activity prepares nurses to optimize nutritional outcomes while preventing necrotizing enterocolitis, extrauterine growth restriction, and metabolic bone disease in vulnerable preterm infants.