Wednesday 07 November 2018
INFANT’s preterm nutrition team last night received the Health and Social Care Professions Driving Quality and Improvement Award for their BabyGrow Project. The winners were announced at the Inaugural Best Practice and Innovation Awards hosted by the HSE’s Health & Social Care Professions Office in the Royal College of Surgeons, Dublin, on the 6th November.
The National HSCP awards recognise and celebrate examples of best practice and innovation.
Pictured L to R: Ms. Sarah Fenton, Senior Pharmacist; Dr. Ann-Marie Brennan, Clinical Specialist Neonatal Dietitian; Ms. Jennifer Wilkinson, Senior Neonatal Dietitian; Mrs. Annemarie Fanning, Dietitian Manager; Dr. Brendan Murphy, Consultant Neonatologist.
BabyGrow: Translating Research into Improved Nutritional Care for Preterm Infants was a multi-disciplinary preterm nutrition project, led by Prof Mairead Kiely (Nutrition Scientist, INFANT Nutrition platform lead), Dr Brendan Murphy (Consultant Neonatologist) and Dr AnnMarie Brennan (Neonatal Dietitian). The collaboration in preterm nutrition between Cork University Maternity Hospital (CUMH), University College Cork (UCC), industry and the HSE was initiated over a decade ago and continues to grow within the Nutrition platform at the INFANT centre.
The goals of the BabyGrow study was to quantify nutritional support and growth rate in preterm infants in the NICU and to develop and deliver data driven innovations for improvement of nutritional support.
Dr Brennan conducted her PhD on BabyGrow and her analysis of parenteral nutrition, the focus of the HSCP award, was a transformative piece of research, which led to the development and implementation of a new intravenous nutrition solution for safer and better nutritional support in the NICU.
In Ireland, ~1 in 100 babies (~600 babies per annum) are born preterm and very low birth weight (VLBW <1500g). One in four preterm infants has evidence of developmental delay by the time they reach school-age. Appropriate nutrition during early life is essential for healthy growth and neurological development. As these vulnerable infants transition from exclusively intravenous nutrition onto milk feeds over the first 7 to 10 days of life, nutrition provision is complex and challenging, with a high risk for adverse short and long term effects. In the absence of evidence-based practice guidelines, nourishing preterm infants during this critical period has traditionally been based on a ‘best guess’ approach.
The BabyGrow nutrition and growth study revealed substantial nutrient deficits and growth failure in VLBW infants during the first weeks of life. This had been observed previously in other units, but the BabyGrow database, which was uniquely designed to provide the most disaggregated and detailed portrait of nutrient delivery within the NICU, provided a first-time opportunity to conduct in silico data modelling experiments. The outcome of this data-driven approach was the development of novel parenteral products with improved nutritional composition, making them suitable to deliver recommended levels of nutrients to support growth without providing excessive intakes. This is the first time nutrient modeling has been used to determine the composition of intravenous nutrition that fully meets the needs of VLBW infants, who have a complex nutritional journey. The team partnered with industry to translate this research into clinical practice and embarked on a 6 month product development phase.
In February 2018, following a dietitian-led implementation strategy, the two new intravenous nutrition products, supported by an evidence-based guideline, were introduced into CUMH. The post implementation audit shows full adoption with infants receiving safer and better nutrition. To date, this work has been published in four international peer-reviewed publications and the evaluation is ongoing.
As part of the PiNPoINT (Personalised Nutrition for the Preterm Infant) project, funded by a consortium led by Science Foundation Ireland, the same team is observing infants receiving the new intravenous nutrition products and conducting detailed growth, developmental and neurological assessments in these babies throughout their hospital stay and during infancy.
The National Clinical Programme for Paediatrics and Neonatology Parenteral Nutrition Expert Group have endorsed the new products and evidence-based guideline and national rollout is planned. Utilising the improved intravenous nutrition products instead of bespoke individualised prescriptions on a daily basis will deliver cost savings of ~€60,000 per annum to CUMH, a 20% saving on our overall intravenous nutrition costs supply, with potential for far greater cost savings nationally. Very positive feedback has been received from a staff evaluation, who have reported the new developments as “user friendly”, “easy to follow”, “prescribing is easier and safer” and, “babies in my care are receiving better and safer nutrition”.
This collaborative project, between HSE dietitians, neonatologists, pharmacists and nutrition scientists at UCC, has delivered innovative, evidence-based solutions to a long-standing unmet need for the benefit of the most vulnerable people in society.