Introducing our Preemie Feeding Tracker and Preemie Fortification software for Neonatal Intensive Care Units

The combination of these two software works in conjunction with the Preemie sensor, allowing neonatologists and nurses to: test milk composition, freshness, and safety; automatically suggest the fortification needed for each preterm infant; store and keep track of key data about infants’ nutrition and growth; track and manage each infant’s feeding and correlate it with the infant’s growth; prescribe the next fortification needed.

  • Collects and stores the results of each milk analysis, with the following parameters being measured:

Composition: Total Protein, Total Lipids, Lactose, Total Human Milk Oligosaccharides, Energy

Freshness (based on bacteria count)

Safety (based on somatic cell count)

  • Automatically calculates the suggested targeted fortification and enables a digital prescription of the fortification on a daily basis;
  • Customization of fortification guidelines, fortifiers used, and introduction to fortification;
  • Stores data about infant feeding (prescription and actual intake) and growth, in compliance with GDPR;
  • Comprehensive management of each infant’s nutritional intake and growth over time, allowing the user to correlate actual intake and growth indicators, and to get insights into the evolution of the infant’s health status;
  • Produce, save, and export reports on infants’ nutrition and growth.

How Our Preemie Preterm Feeding Management System Works

 

 

To learn more about what Preemie can do to help vulnerable infants get a healthy start in life, please contact us to arrange a demo or to use our Preemie sensor and software in your research.

Preemie Systems Speaking and Sponsoring at the HCSA Conference 2020

HCSA Conference 2020

Preemie systems is pleased to announce that it will be the part of this year’s HCSA Conference – Past, Present and Future, as a sponsor and speaker.


This year’s virtual conference and exhibition of The HCSA Annual Conference & Exhibition (HCSA Reunite 2020), will occur on the 17th and 18th of November. This event holds a special place within the community of clinicians and other key stakeholders of NHS procurement, highlighting the need to improve, adopting common standards, introducing key performance indicators, implementing better information systems and innovation. It’s also an opportunity for future connections, enhancement of professional networks and engagement possibilities.

Preemie’s Systems CEO Isabel Correa (Hoffmann), is honoured to speak and present on day two ‘The Preemie System: Connectivity, Traceability and Transparency in the Routine Analysis of Human Milk Composition’.

The Preemie system, which personalises the concept of target fortification using our award-winning Preemie sensor (a portable and affordable NIR sensor specifically calibrated for human milk), is thrilled to be part of this event.

Visit our Booth!

Preemie System Wins German Design Award for its Preemie Sensor in the Category of Medical, Rehabilitation and Health Care

German Design Award

Preemie sensor is a small, portable device created for neonatologists, nurses, and human milk bank professionals to analyse milk for its nutritional value, spoilage, and safety.


November 13, 2020 – London, England | The German Design Award is one of the most prestigious awards on the European and international scene in the design sector. Only the best products and innovative projects are awarded, after a selection by a commission of renowned experts, who are members of the German Design Council. We are proud to announce that our Preemie sensor is a recipient of this prestigious award in the category of Medical, Rehabilitation and Healthcare.

We believe that participation in this competition, which over the years has become a showcase for the best international projects, provides a global platform that strategically positions the Preemie System with respect to the design of the products it develops.

“Winning this prestigious award is a great honour for our team,” says Isabel Correa, CEO and Founder of Tellspec LTD, the company that is developing the Preemie System, “It confirms our company’s ability to innovate across the board in all aspects of product development, including design. The German Design Award also allows our Preemie sensor to be present in the different European and International communication channels, further amplifying the scope of our mission of helping preterm infants get a healthy start in life”.

The design of the Preemie sensor was developed to reflect the brand, and took into account operational functionality, portability, weight, and ergonomics, with the aim of simplifying our users’ understanding of how to use the device. This design flow is reflected in the user interface of our Preemie software ecosystem:

A great deal of work has been done on the language of the device and on the semantic design aspects, so as to convey the perception of a smart and easy-to-use product. The Preemie sensor, soft in colour compared to other medical devices, at the same time is portable and durable. Our goal was to create a product design which stands out amongst commonly used medical devices within the marketplace, for its user-friendly design, thus making it disruptive and innovative.

THE COLLECTION AND ANALYSIS OF BREAST MILK: Past, Present, and Future

From ancient times to the present day, the sharing of breast milk has had an interesting history from myth to misconception to a revolution of support by global agencies such as the World Health Organisation and UNICEF. This month’s blog touches upon the history of breast milk collection and analysis past, present, and future.

PAST

In ancient times, the ‘collection’ of human milk was simply nursing of the infant by family members, friends, or even strangers. The earliest recorded account was around 1800 BC during the Babylonian Code of Hammurabi. Between 100 and 400AD, an analysis of determining the milk’s quality and consistency was done using the fingernail test by placing a drop of breast milk on the nail. If the milk ran when the finger moved – too watery. If when the fingernail was turned downward, and the milk clung to the nail – too thick.

“It takes a village to raise a child” – African proverb.

The wet nurse’s evolution went from a community of family members and friends helping one another to women who served the wealthy. In fact, a wet nurse was a reputable, well-paying profession that earned more than a general labourer during the Victoria era.

As the popularity of wet nursing declined by the mid-19th century with human milk being replaced by alternative animal milk sources, a physician named Theodor Escherich led the way in pediatric infectious disease research. He discovered that breastfed babies’ intestinal bacteria greatly contrasted with infants fed with an animal milk alternative. Under the tutelage of Escheric, who in 1902 became the Chair of Pediatrics at the University of Vienna and Director of the St. Anna Children’s Hospital in Vienna, Vienna opened up the very first human milk bank in 1909. Human milk was pooled and pasteurized before distribution as milk analysers weren’t invented until the 1980s for the dairy industry, with human milk analysers to follow years later.

PRESENT

Today, there are hundreds of human milk banks worldwide of individual milk banks overseen by various national associations such as the European Milk Bank Association, Human Milk Banking Association of North America and the Rede Brasileira de Bancos de Leite Humano in Brazil. Women generously donate their breast milk to help the most vulnerable low-birth-weight infants in hospitals’ Neonatal Intensive Care Units.

Human milk banks are the gateway to supplying breast milk to hospitals. Their service is essential as they are “responsible for recruiting breast milk donors, collecting donated milk, and then processing, screening, storing, and distributing the milk to meet infants’ specific needs for optimal health.” (PATH report on Strengthening Human Milk Banking – A Global Implementation Framework). At times, the screening process may also include the use of a human milk analyser to measure the macronutrient content in breast milk, like fat, protein, and energy. This additional information assists NICU doctors to decide the type and amount of fortification required to supplement the breast milk given to meet each preterm infant’s needs.

Early in the development of our Preemie system, we interviewed several milk bank managers and neonatologists to get a better understanding of their needs for human milk analysis. It was important for us to develop an end-to-end solution for precise human milk analysis that met their needs. From these interviews we heard the following comments:

  • “It would be amazing to have software that could do the fortification calculations.

  • “We need software that can track the nutritional intake and correlate it to the infant’s growth.

  • “It would be great to have a smaller device that rapidly and easily tests the donor milk composition”

  • “We want to use as little milk as possible while performing the composition analysis.”

  • “We need to automate the process of fortification, and discard manual calculations;

  • “We need an affordable device that can test the milk freshness so we know if we should use the milk for infant feeding.”

  • “I need a simple and easy-to-use device that can test the milk composition but that doesn’t require recurrent calibrations.”

  • “It would be great if after testing the donor’s milk we could print a nutritional label with that information.”

  • “Would be great if we could test several donor milks and have the software tell us what milk should be pooled together so as to optimize the pooled milk with the highest possible nutritional quality.”

 

FUTURE

Based on the feedback, we are currently developing our Preemie System that can meet the requirements and needs of NICUs and of HMBs. You spoke and we listened!

Preemie Systems Joins the 2nd International Donor Milk Research Congress

European Milk Bank Association

Preemie systems is pleased to announce that it will be the main sponsor and speaker at this year’s 2nd International Donor Milk Research Congress.


The European Milk Bank Association (EMBA) virtual research meeting will take place on October 2nd, 2020 and will focus on “Human Milk Donation and Breastfeeding in the COVID-19 Era”.

The European Milk Bank Association (EMBA) gathers over 200 milk banks operating in more than 20 countries throughout Europe. This congress will reunite the most reputable researchers from all over the world, and is one of the most exclusive events in the field.

Preemie’s Systems CEO Isabel Correa (Hoffmann), is honoured to be presenting ‘The Preemie System: Connectivity, Traceability and Transparency in the Routine Analysis of Human Milk Composition’, at EMBA’s prestigious event.

The Preemie system, which improves the concept of target fortification introducing a portable and affordable NIR sensor specifically calibrated for human milk, is glad to be part of this event.


Are you a human milk bank? Take a couple of seconds to learn more about the #HumanMilk4Life campaign or to participate, please visit our webpage.

ABOUT PREEMIE SYSTEMS
The Preemie Systems is the first end-to-end solution to individualised, targeted milk fortification by taking into account the unique chemistry of human milk in a rapid, reliable, cost-effective, and portable sensor with state-of-the-art machine learning algorithms and dedicated software for analysing, fortifying, tracking, and reporting information about infant growth and its correlation to the milk fortification given. The Preemie System offers a digital, transparent, and comprehensive solution for all Neonatal Intensive Care Units and human milk banks.

Launch of the #HumanMilk4Life Campaign

Mum playing with newborn infants' feet

Celebrating the extraordinary power of human milk and the role that human milk banks have within their communities by sharing their stories, raising awareness, and educating women on the value of human milk donations.


September 22, 2020 – London, England | Today, Preemie Systems launches the #HumanMilk4Life digital campaign to raise awareness of the importance of human milk, its life-saving properties, and the need for women to donate their breast milk to help vulnerable low-birth-weight infants.

We believe that sharing these informative ads, offered at no cost to the human milk banks (HMBs), is essential as we wish to:

  1. Raise awareness of local human milk banks and their services
  2. Raise breastfeeding awareness and the importance of mothers donating their milk
  3. Highlight the collaboration between the human milk banks and the Neonatal Intensive Care Units (NICU)
  4. Emphasize the importance of the life-giving nutritional and biological properties of human milk

The #HumanMilk4Life social media posts are designed to engage the target audience with information about HMB services and the need for human milk donations. Each post will connect social audiences to their local human milk bank, hospitals, and associations with links to their website and tags to their social media platforms. Advertisements will be placed on Facebook and Instagram with accompanying posts on Twitter and LinkedIn.

“We are pleased to announce that Italy will be the launch-pad for the Preemie Systems #HumanMilk4Life campaign,” remarked Professor Guido E. Moro, President of the Italian Association of Donated Human Milk Banks (Associazione Italiana delle Banche del Latte Umano Donato, (AIBLUD). “This campaign will help raise awareness of the need for human milk donations within our communities and help mothers and their preterm babies.”

The #HumanMilk4Life campaign will start in Italy and flow to other selected human milk banks throughout Europe.

“Breast milk is valuable, especially for vulnerable preterm infants concerning their short and long-term health, and the mother’s milk may not be available, especially in the first period after delivery.” remarked Professor Enrico Bertino, President of the European Milk Bank Association (EMBA) and Professor of Pediatrics, Director of the Neonatology Department at the University of Turin (AOU Città della Salute e della Scienza “Donated human milk is essential because it represents the most valid alternative to breast milk and is the first choice when breast milk is not available. For premature babies, it can be considered as a life-saving drug.”

Although breast milk is the optimal choice for preterm infants, sometimes the mother is unable to provide the amount required to feed her baby. This is when donors’ milk is needed and where milk banks help, facilitating the process of collecting and distributing human milk to their associated hospitals.

Breast milk is not just nourishment for vulnerable infants, but a vital gift that helps them grow up healthy!

The main benefits for premature infants who receive donated human milk instead of formula are improved food tolerance, faster achievement of full enteral feeding, improved bowel growth and maturation, decreased risk of enterocolitis necrotizing, bronchodysplasia and retinopathy of the premature baby and better neurodevelopment, as indicated in the recent AIBLUD and EMBA recommendations.

To learn more about the #HumanMilk4Life campaign or to participate, please visit our webpage.


ABOUT PREEMIE SYSTEMS
The Preemie Systems is the first end-to-end solution to individualised, targeted milk fortification by taking into account the unique chemistry of human milk in a rapid, reliable, cost-effective, and portable sensor with state-of-the-art machine learning algorithms and dedicated software for analysing, fortifying, tracking, and reporting information about infant growth and its correlation to the milk fortification given. The Preemie System offers a digital, transparent, and comprehensive solution for all Neonatal Intensive Care Units and human milk banks.

Cutting the Risks of Premature Birth

Around half a million babies are born prematurely each year in Europe and that number is increasing.


Where premature birth can’t be prevented, it’s vital that preemies receive adequate nutrition to help prevent health problems. Babies born early often don’t get all the nutrients they need from breast milk alone as it provides less protein, fat, and carbohydrates than they would get through the placenta if they were still in the womb.

‘When we have a very premature baby, nutrition (from breast milk) is not enough so it has to be fortified,’

said Isabel Correa, founder and CEO of a company called Preemie based in London, UK.

Currently, preterm infants are often given breast milk with standard fortification in hospital neonatal units. Doctors typically give babies urine tests to gauge if the supplementation is suitable. But since it isn’t tailored to individual needs or to the specific human milk used, there is a risk of under- or over-fortifying the milk, which could have side effects including renal failure or predisposing the child to obesity.

Correa and her colleagues are developing a system to test the nutritional content of the mother’s milk in a few seconds and calculate the fortification required based on a baby’s needs. It can measure how much protein, fat, lactose, and oligosaccharides – complex sugars – are found in breast milk – as well as freshness, or the age of the milk in days.

“We are working towards enabling neonatal ICU (intensive care unit) professionals to perform a quick and reliable analysis of a small amount of breast milk, thus providing better individualised fortification for preterm babies,”

said Professor Enrico Bertino, a professor and director of the Neonatal Care Unit at the University of Turin in Italy, who is involved with a study of the Preemie device.

To read the full article, visit: https://horizon-magazine.eu/article/cutting-risks-premature-birth.html

Helping Preterm Babies Get a Healthy Start In Life

Ensuring that each preterm infant receives optimal nutrition by supplementing the mother’s milk through personalised, targeted fortification designed to meet the infant’s unique nutritional needs.


The Preemie team spoke with Leilani Kupahu-Marino, a Registered Nurse who works at the Neonatal Intensive Care Unit at the Tripler Army Medical Center, in Hawaii, USA, to get her perspective on the journey that families face when their baby is born early and the challenges they have. Here is what she said:

“So, let’s start from the beginning. Mother is expecting to deliver this baby full-term, suddenly something happens, and Mother is brought into Emergency for either a C-Section or delivery. In those moments, everything is exploding in their world. Their life has changed from ‘Excitement’ to trauma as all of a sudden the baby is whisked away to the Neonatal Unit (NICU). Mother has not touched the baby and depending upon how preterm baby is, it may be several days before Mum has an opportunity to even see baby.

Our focus during this time is to stabilise the baby and ensure that Mum is well looked after.

As soon as possible, we collect the Mother’s milk, and when the Doctor says it’s OK to start feeding the baby, then we would give those few drops to the baby. Once the baby is stabilised we then look at fortifying the breast milk.

In my 25 plus years of being in the NICU, I’ve seen this same process: the NICU doctor uses a standard mathematical calculation for calories based on changes within a 24 hour period, and this is what the baby will receive in the volume of the Mother’s milk, including fortification. Maybe the baby is 5 to 7 days out in the NICU, and the baby is not gaining, so let’s give them a 24-Kcal.

OK, then maybe it’s a week, 2-weeks and baby is gaining weight, things are getting better, let’s go down to from 24 to 22 Kcal and if still doing well working towards straight mother’s breast milk. It really comes down to that math calculation of what baby needs in Kcals. Still, it is not taking into consideration the macronutrients of the mother’s breast milk that they are getting, and that is why Preemie is phenomenal!

The soul of that little baby… and each one is different, and we need to look at them as individuals. So yes, the mathematical calculations for fortification work today. However, it doesn’t always provide the proper amount of nutrients needed to individualise the amount for fortification. And, if miscalculated, the baby’s abdomen can become distended as they may not tolerate the amount of fortification given.

To me, Preemie system now gives doctors specific information regarding the macronutrient content within the breast milk, they will also have the option to add other nutrients along with the fortifier such as probiotics. All of this becomes more specific to that particular baby meeting their own personal and individual requirements.

Who knows, maybe we will be able to monitor their intake in such a way that that could affect the long term health of that particular child and decrease interventions and decrease the obesity that happens and other issues that occur in adolescence and into young adulthood.”

#Pretermnutrition #preterm #preemie #preemiesensor #NICU #healthybaby


Interested in learning more about our Preemie sensor or wish to collaborate with us? Please contact us for more information.

Preemie Sensor Infographic

The Future of Individualised Targeted Fortification and Why It Matters to Preemie Babies

Fortifying breast milk is not a ‘One Size Fits All’ solution. Today, we are looking towards the future of identifying your baby’s individual nutritional needs.

We believe that every preterm baby should be given the best chance to thrive in this world by fortifying the mother’s breast milk with additional nutrients. It is essential to identify the levels of nutrients in breast milk and determine what nutrients need to be added to provide the optimal source of food for your preemie baby.

Preemie is a handheld system designed with a Near-InfraRed (NIR) spectrometer supported by an Artificial Intelligence (AI) computation engine. The sensor analyzes the breast milk and enables neonatologists and pediatricians to analyze its composition and provides this information via our app. The app then lets doctors know the total amount of protein, lipids, carbs, lactose, Human Milk Oligosaccharides (HMOs), energy, water and the freshness of the breast milk. With this information, doctors are then able to make informed decisions to create a personalized nutritional formula to supplement breast milk.

Why is Individualised Targeted Fortification Important?

A mother’s breast milk is known to have the best nutrients and infection-fighting properties required for your baby, especially Human Milk Oligosaccharides, which are unique to human milk. However, for preterm babies, it can be challenging to meet the infant’s nutritional requirements and more often than not, requires the milk to be supplemented (fortified) with additional nutrients.

Most neonatal units today use a Standard Fortification method whereby a fixed amount of off-the-shelf multi-nutrient fortifier is added to breast milk. This product, typically a liquid or powder, is added to a given volume of breast milk to reach the required nutritional recommendation. However, we need to consider the following:

  • That there is high variability in breast milk concerning macronutrients.
  • This fixed amount is calculated based on the assumption that all human milk has a fixed protein content.
  • The infant’s precise nutritional needs change with age and growth.

This ‘One Size Fits All’ approach does not account for the inconsistency in the amounts of protein and lipids within human milk and therefore can run the risk of overfeeding or underfeeding the preemie baby.

There MUST be a BETTER WAY! And there is 🙂

“Today, we are working towards enabling NICU professionals with the ability to perform quick and reliable analysis using a small amount of breast milk. The goal is to provide preterm infants with a better feeding solution by individualising the fortification added to the breast milk.Remarked Professor of Pediatrics, Enrico Bertino, Director of the Neonatology Department at the University of Turin and President of the European Milk Bank Association (EMBA). “With the Preemie system, doctors will be able to quickly and easily determine what additional nutrients are required to reach optimal fortification of the infants’ personal nutritional needs. If the preterm infant is fed too much or too little of macronutrients supplement, it can hinder the health and growth of a preterm infant.”

Targeted fortification of human milk makes it possible to ‘Individualise’ the fortification of breast milk. The objective is to ensure that your baby receives the RIGHT AMOUNT of macronutrients to help your baby grow happy and healthy. Your preemie baby must receive these nutrients in the targeted amounts to avoid possible long-term effects of inadequate nutrition, such as:

Inadequate nutrition may result in:

  • Impaired neurocognitive development.
  • Long-term cardiovascular complications.
  • Significantly lower bone mineral density.

Overnutrition may result in:

  • Risk in later life of metabolic complications such as the increased risk of obesity and insulin resistance (diabetes).
  • Possible kidney complications.

The Challenge

When preterm infants are born, they have additional nutritional needs compared to full-term infants. To address these requirements, Neonatal Intensive Care Unit (NICU) professionals typically add a standard amount of fortifier to human milk to increase the amount of nutrients present in the milk, particularly protein, which plays a crucial role in an infant’s neurological development.

Although this approach of standard fortification improves the infant’s overall nutrition, it does not take into account the natural variability of breast milk, which significantly fluctuates throughout the infant’s first month of life. The only way to ensure that an infant is receiving the right amount of nutrients is by analysing the composition of the breast milk, which can be:

  • Expensive in both equipment and human resources.
  • Time-consuming as samples need to be sent to labs for analysis.
  • Wasteful of a large sample of breast milk.

The Preemie system addresses this challenge by providing a comprehensive solution developed explicitly for human milk singularities and disparities.

The Future of Preemie and How We Will Help Preemie Babies Thrive

Preemie disrupts the existing market by allowing NICUs and human milk banks to scan donor milk, automatically calculating individual fortification, as well as to test the authenticity of the milk. This is achieved by developing machine learning models from laboratory reference analysis of many samples of human milk.

We are unique in this space as our Preemie Sensor is rapid, affordable, portable, and minimises the human error of calculating fortification since it automatically suggests the fortification of the human milk based on the nutritional needs of each specific infant and the current composition of mother’s milk. Two primary features are:

Provides a complete analysis: Its single purpose is to test the composition of mother’s milk and suggest a fortification of this milk so as to meet the unique nutritional needs of her baby. For this reason, the sensor delivers a reliable analysis of human milk composition that goes beyond the basics. In addition to testing the standard macronutrients (protein, fat, and carbohydrates), Preemie also analyses total HMOs and the freshness of the milk and whether it was adulterated (e.g. diluted).

Easy to use: The healthcare provider just needs to put a few drops of milk into a cuvette, and insert it into the portable Preemie Sensor. This process requires only 30 uL of human milk, and takes less than 30 seconds to obtain the analysis.

Closing Thoughts

The nutrition received in the first few weeks of life are incredibly critical to preemie babies. It is a stressful time for mothers wondering if their newborn is receiving the nutrients their baby needs to thrive. Even with current standard fortification methods, there remains an uncertainty whether their child is receiving all the nutrients they need. By providing the solution of individualised targeted fortification designed to be personalised to meet the infants needs, doctors and mothers can have peace of mind knowing that their child is receiving the nutrition they need during this delicate time of their life.

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About the Technology
Preemie is a handheld system composed of a Near-InfraRed (NIR) spectrometer (the sensor), an AI computation engine operating in the cloud, and a dedicated mobile application. The Preemie system tackles the problem of undernourishment in underweight infants by providing reliable analysis of human milk composition and information on how to fortify the milk to achieve personalised nutrition for the infant. Our Preemie system also correlates the growth of the infant with the detailed fortification given, thereby providing invaluable data to neonatologists and pediatricians on how to achieve optimal infant health.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 879228

 

About Professor Enrico Bertino
Enrico Bertino is a Full Professor of Paediatrics at the University of Turin. He is currently the Director of the Neonatal Care Unit at Turin University, located in Sant’Anna Hospital, the largest European national health hub. He is also in charge of the clinical activities of the Donor Human Milk Bank in the hospital. As a reference center for high-risk pregnancies, very preterm and critical newborns, S. Anna hospital has overall more than 6,000 deliveries per year with more than 100 very low birth weight Infants per year.

He is President of the European Milk Bank Association from November 2018 and also a Founder Member of the Italian Association of Human Milk Banks and has authored over 250 scientific publications in international journals, mainly regarding neonatal nutrition and growth.

Professor Bertino specific interests include:

  • Neonatal Nutrition and Metabolism
  • Neonatal Intensive Care
  • Breastfeeding Promotion
  • Biological and Nutritional Aspects of Human Milk
  • Follow-up of Preterm Infants
  • Fetal and Postnatal Axiology
  • Perinatal Health Care Quality
  • Family-centred Care

Human Milk Fortification Strategies for Low Birth Weight and Preterm Infants

Breast milk is recognized as the best source of nutrition for newborns and its use is officially recommended to feed term and preterm babies. When breast milk is not available, donated human milk can be used.

Human milk is an incredible product of evolution that naturally contains all the nutrients needed by newborns and components, such as human milk oligosaccharides (HMOs), which only mothers can produce. You can discover more about the unique characteristics of human milk in this article.

In addition to its nutritional benefits, breast milk helps newborns to strengthen the immune system, improve long-term neuro-cognitive development and, in the case of preterm infants, offers protection against the main complications that can arise during the stay in the Neonatal Intensive Care Unit (NICU).

 

Preterm babies need more

Preterm infants and all low birth weight (LBW) infants, have special nutritional needs, and sometimes human milk, despite its extraordinary characteristics, may not be sufficient to meet those needs. Human milk is a very complex substance whose nutritional values as protein, fat and HMOs change over time, making it an ever-changing substance from the chemical composition point of view.

For example, the most critical period for brain growth and development in humans corresponds to the third trimester of gestation; preterm babies who are born within this period may miss the placental transfer of nutrients needed during the postnatal period. This could mean that these babies will have greater nutritional requirements, more than those offered by the mother’s milk.

To overcome these problems, NICUs enrich the mother’s milk with specific nutrients to ensure optimal development and growth of preterm babies.

 

Human milk fortification strategies

The use of human milk fortifiers for preterm infants is now considered a common practice in most NICUs; they rely on fortifiers that differ in the origin (bovine, human or donkey milk) and composition (multi-nutrient fortifiers or supplements for proteins, lipids and carbohydrates). In particular, for preterm infants, protein supply is extremely important: protein intake deficiency affects growth and carries the risk of neuro-cognitive impairment.

The standard approach to human milk fortification calls for the addition of a standard amount of fortifier to a specific amount of milk, regardless of the nutritional content of the human milk. It is a very rapid and inexpensive fortification strategy which, however, does not take into account the needs of the individual infant nor the intrinsic variability in mother’s (or donated) milk macronutrients. As a result, standard fortification makes it almost impossible to achieve the internationally recommended nutritional targets, leaving space for potential negative consequences in terms of growth and development of infants.

In general, standard fortification can provide right energy intakes but is not recommended to provide the correct protein intake for very low birth weight and preterm infants. Besides, standard fortification increases the risk of incurring in infants’ over-nutrition, which can have serious health consequences as well. In order to favor the optimal growth of preterm infants in NICUs, it is, therefore, necessary to adapt the fortification strategy to the specific needs of each child over time.

The scientific community and experts are now engaged in promoting the practice of individualised fortification, which is believed to be the solution to the problem of low birth weight and preterm infants’ undernourishment. Individualised fortification consists of two methods, adjustable fortification and target fortification.

Adjustable fortification was designed specifically to avoid protein under-nutrition and over-nutrition: the logic behind this approach is to regulate protein intake based on the child’s metabolic response. Even though Blood Urea Nitrogen (BUN) levels only roughly correlate with the protein intake in infants, BUN is used to guide the amount of additional protein needed. NICUs analyze BUN levels twice a week and intervene accordingly, fortifying milk with the right protein intake for each child.

Adjustable fortification has the clear advantage of taking into account the actual protein levels of preterm children, therefore reducing the possibility of incurring in under- or over-nourishment. The reliability of the approach can be undermined by the fact that, in premature babies, BUN values ​​may be subject to confounding values. Furthermore, the variability of milk is also not considered.

Target fortification is about human milk and its characteristics. Human milk composition is analyzed in order to identify its wide range of macronutrients so to perform a targeted fortification that does not just focuses on protein, but also on other macronutrients that play an important role in baby’s development. Another benefit of this approach is the ease of analysis, the repeatability of which allows to take into account the natural variability of human milk. Recent improvements in this approach made target fortification a promising fortification practice: in this context, the European Commission funded a project that has the potential to innovate low birth weight and preterm health.

With Preemie, the analysis of human milk is performed via a NIR (Near InfraRed) spectroscopic sensor and NICUs’ operators get results in real-time, and can fortify milk accordingly, using single components fortifiers (i.e. each fortifier addresses one or more class of macronutrients). Until recently, target fortification has been considered impractical due to the size and high cost of the analyzers, the time it takes to get a result, the time-consuming procedures to analyze human milk and the need of skilled personnel performing the analysis.

Preemie system improves then the concept of target fortification introducing a portable and affordable NIR sensor specifically calibrated for human milk that will allow NICUs’ operators to easily perform human milk analyses. The system features an AI-engine running in the cloud able to provide precise recommendations on the fortification, correlating optimal growth for each infant over time. Preemie also helps milk banks by allowing donor’s milk traceability through a blockchain protocol and testing for spoilage before milk is pooled.

 

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