Giving premature babies a stronger start: how PremSmart transformed neonatal nutrition in Ireland
For babies born too soon, the first days of life are critical. During this period, nutrition plays a critical role in brain development, growth and long-term health. But for many years, delivering that nutrition safely and consistently was one of the most complex challenges in neonatal care.
Clinicians relied on a highly individualised approach to intravenous nutrition, prescribing nutrients one by one. It was complex, time-consuming and difficult to standardise. In fast-changing environments, delays between prescribing and delivery meant that by the time nutrition reached a baby, their needs could already have changed. Even when everything worked as intended, many babies experienced gaps in nutrition during this crucial stage.
From research to practice
PremSmart was developed to address this challenge.
PremSmart combines specially designed intravenous nutrition formulations with a decision-support system that helps clinicians match nutrition more closely to a baby’s changing needs.
The work began through research closely connected to clinical practice, shaped by the challenges faced in neonatal units. Developed through collaboration between the INFANT Research Centre and the Health Service Executive (HSE), the system is designed to support babies through one of the most complex stages of care — when they transition from intravenous feeding to milk.
National impact
Today, PremSmart is used in neonatal units across Ireland and has become part of routine care in the majority of cases. This level of national adoption is rare, particularly for something as complex as intravenous nutrition.
This is reflected in how it is now used in practice across neonatal units.
Prof Anne Doolan, Consultant Neonatologist at The Coombe Hospital, says:
“We use the PremSmart program every day in our Neonatal Unit. It has standardised practice which means that every baby gets excellent nutritional care.”
Babies are now more consistently reaching recommended nutritional levels during this early stage, supporting better growth. For healthcare teams, the system simplifies a previously complex process, reducing variation and easing workload. For the health service, it has delivered efficiencies, including cost savings of around €1 million per year.
For families, the impact is less visible but just as important. Parents of preterm babies must place enormous trust in clinical teams during an already overwhelming time. Knowing that care is supported by a consistent, well-designed system offers reassurance when so much else feels uncertain.
Clíona O’Donoghue, whose daughter Sadhbh was born at 26 weeks, describes the experience:
“My daughter Sadhbh was born at 26 weeks, weighing just 2 lbs 3 oz. The neonatal journey can be overwhelming, and we placed complete trust in the team caring for her. We lived from one weigh-in to the next, seeing every gram gained as a sign of progress and hope.
Knowing she was receiving the right nutrition at such a critical stage made a huge difference. Any advancement that improves outcomes for these tiny babies and helps families feel more connected to their child’s journey, is invaluable.”
From implementation to policy
PremSmart also highlights an important part of healthcare innovation: ensuring that new approaches work in real-world settings and can be sustained over time.
Experiences in other countries have shown that scaling up new nutrition systems can carry risks if not carefully managed. In response, the PremSmart programme has focused not only on developing the system, but also on understanding how it works in practice — including training, support and day-to-day use.
This work is now helping to inform how the system is supported nationally, from training to audit and oversight. In doing so, PremSmart is beginning to shape how this type of care is delivered and maintained across the health service.
A model for impact
PremSmart is more than a single innovation. It shows how research, when closely connected to clinical practice, can lead to real and lasting change.
The next phase is already underway. PremSmart 2.0 is being developed as a digital platform, with the potential to further support decision-making and open up new ways of involving parents in their baby’s care.
At its heart, this work is about giving preterm babies the best possible start in life. It demonstrates how research embedded in frontline healthcare can move beyond discovery to reshape care for some of the health service’s most vulnerable patients.
About the research team
Dr Ann-Marie Brennan
Co-Founder Neonatal Clinical Nutrition Research Group and Lead Investigator, INFANT Research Centre
Clinical Specialist Neonatal Dietitian, Cork University Maternity Hospital
Dr Brennan is an established researcher in preterm nutrition with over 25 years of clinical and academic experience. She leads the development, validation and national implementation of PremSmart.
Sarah Fenton
Co-Founder Neonatal Clinical Nutrition Research Group, INFANT Research Centre
Advanced Specialist Neonatal Pharmacist, Cork University Maternity Hospital / Cork University Hospital
Sarah Fenton has over 20 years clinical experience with expertise in preterm nutrition, health informatics and implementation science. She co-leads the development and validation of PremSmart, and is conducting the national evaluation of its implementation.
Together, they lead the Neonatal Clinical Nutrition Research Group at INFANT, focusing on translating research into innovative solutions at the cot-side and delivering measurable improvements in outcomes for babies and the health service.