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.

Preparing for the next pandemic: Lessons from COVID-19, pregnancy and the power of better data

While COVID-19 may no longer dominate headlines, the lessons learned during the pandemic continue to shape how healthcare systems prepare for future public health emergencies. This is particularly true when it comes to protecting pregnant women and their babies.

When COVID-19 emerged, pregnant women faced uncertainty at every turn. Questions about infection risks, vaccine safety, and the potential impact on unborn babies created anxiety for expectant mothers and challenges for healthcare professionals trying to provide evidence-based guidance in real time.

In the early stages of the pandemic, reliable evidence on the safety and effectiveness of COVID-19 vaccination during pregnancy was limited internationally. In Ireland, only 58% of new and expectant mothers had received a COVID-19 vaccine, while studies from the United Kingdom suggested that unvaccinated pregnant women infected with COVID-19 were more likely to require intensive care treatment.

“Monitoring COVID-19 infection and vaccination during pregnancy is important because we know that during pregnancy a woman can be at greater risk of becoming severely ill from the virus,” explains Professor Ali Khashan, Principal Investigator at INFANT, and Professor in Epidemiology in the School of Public Health, UCC.

“When a vaccine becomes available, there is another question – should pregnant women take the vaccine or not?”

To help answer these questions, researchers from INFANT Research Centre at University College Cork (UCC), in partnership with Ulster University, launched the COVICAT project to better understand COVID-19 infection and vaccination during pregnancy across the island of Ireland.

While the project set out to answer questions about COVID-19 in pregnancy and risk of congenital anomalies, it also uncovered a broader challenge. Researchers found that important health information was often difficult to access and connect across systems, limiting the ability to rapidly generate evidence for pregnant women, clinicians and policymakers during a public health crisis.

One reason these findings matter is that pregnant women are generally excluded from clinical trials of new medicines and vaccines.

Dr Mary O’Mahony, Consultant in Public Health Medicine and collaborator on the project, explains:

“Projects such as COVICAT highlight the importance of robust data systems that allow us to monitor the safety and effectiveness of public health interventions during pregnancy and provide reassurance for women and the healthcare professionals caring for them.”

Reflecting on the project’s wider implications, Dr O’Mahony adds that “validated routine surveillance data can inform pandemic response to improve outcomes.”

Without access to high-quality population data, generating timely evidence during a public health emergency becomes significantly more difficult.

Researchers sought to better understand patterns of COVID-19 infection and vaccine uptake during pregnancy across the island of Ireland, and explore whether infection or vaccination was associated with congenital anomalies during foetal development.

By comparing systems north and south of the border, the researchers identified major differences in how maternal health data was collected, linked and used for research. In Northern Ireland, unique Health and Care identification numbers allowed maternity, infection, and vaccination records to be connected across healthcare databases, enabling population-level research.

In contrast, researchers encountered significant challenges accessing comparable data in the Republic of Ireland. Pregnancy status was not consistently recorded across vaccination and infection databases, while fragmented systems and limited data linkage made it difficult to answer urgent public health questions quickly during a rapidly evolving pandemic.

The lessons from COVICAT were subsequently translated into peer-reviewed publications and a policy brief, which outlined practical recommendations to improve data access, linkage and maternal health surveillance. These recommendations included accelerating the implementation of Individual Health Identifiers (IHIs), strengthening data linkage across healthcare systems and streamlining access to population health data for research and public health decision-making.

“In our experience of seeking to access data about pregnancy and COVID-19 infection and vaccination, once we were put in touch with the right individuals, they were very helpful,” says Professor Khashan. “But there are systemic issues that need to be addressed for the data to be useful for delivering better healthcare.”

Beyond identifying gaps in the system, the project demonstrated how better data can directly support patients and clinicians during future health emergencies.

“Better collection and use of data would help the healthcare system to prepare initially and then monitor the health of these populations during an emergency,” says Professor Khashan. “This would provide reliable evidence to inform timely public health interventions and support to help them.”

For pregnant women and healthcare professionals, this means faster access to the evidence needed to make informed decisions during future public health emergencies.

The project’s European analysis, using EUROCAT data, is expected to contribute valuable evidence around COVID-19 infection, vaccination uptake, and risk of congenital anomalies, helping clinicians provide informed advice and reassuring pregnant women who may have concerns about vaccination.

The work reinforced the importance of cross-border collaboration in addressing shared healthcare challenges. The partnership brought together expertise in public health, epidemiology, maternal health, congenital anomaly surveillance and health data research from both sides of the border.

“The all-island approach was critical because infections know no borders,” says Dr Maria Loane, Leader of the Centre for Maternal, Fetal an Infant Research at Ulster University and Co-Principal Investigator of COVICAT. “Bringing together expertise and data from both jurisdictions allowed us to compare healthcare systems, identify important gaps and demonstrate why stronger maternal health data infrastructure will be essential for responding to future pandemics and public health emergencies.”

The collaboration demonstrated how research partnerships can help identify shared challenges, accelerate learning and generate evidence that improves healthcare policy and future pandemic preparedness.

Although the pandemic has passed, the lessons from COVICAT remain highly relevant. The project demonstrated that protecting pregnant women and babies during public health emergencies requires not only scientific expertise, but also accessible health data, strong research partnerships and collaboration across healthcare systems.

Through collaborative research and all-island partnership, COVICAT has helped strengthen understanding of how health systems can better support pregnant women, clinicians and policymakers during times of crisis, while helping to build more resilient healthcare systems for the future.

Further reading

COVICAT was recently featured in the Higher Education Authority’s North South Research Programme: Insights on Impact report, which showcases the impact of all-island research collaborations.