Early Nutrition as a Modulator of Neurodevelopment via the Gut Microbiota in Preterm Neonates

Preterm birth is associated with a higher risk of neurodevelopmental adverse outcomes later in life. This increased risk is partly due to interrupted brain development during critical early periods. Early nutrition is a key factor that can influence both brain growth and the development of the gut microbiota, which plays an important role in overall health. Evidence shows that human milk, including fortified human milk, supports the growth of beneficial gut bacteria such as Bifidobacterium and Lactobacillus. These bacteria help protect the immature intestine, reduce inflammation, and support normal development. In contrast, formula feeding, frequent use of antibiotics, and perinatal stress, common conditions for preterm infants in neonatal intensive care units, can disturb the normal development of the gut microbiota. These factors may lead to dysbiosis, a state in which harmful bacteria become more dominant. Early changes in gut microbiota may affect brain development through the gut–brain axis. This communication system connects the gut and the brain through immune responses, metabolic products, and hormonal pathways. Disruption of this system during early life may have long-term effects on cognitive, motor, and behavioral development. Both clinical and experimental studies suggest that improving early nutrition may support better neurodevelopmental outcomes. Nutritional strategies such as optimizing protein and energy intake and using probiotics or prebiotics may help promote a healthier gut microbiota and support brain development. In conclusion, early nutrition in preterm infants plays a crucial role during a sensitive period of brain development. By supporting healthy gut microbiota formation, early nutritional interventions may help improve long-term neurodevelopmental outcomes in this vulnerable population. The aim of this narrative review is to explore the relationship between early nutrition, gut microbiota development, and later neurodevelopment in preterm neonates.