Is targeted fortification cost-beneficial?

Several studies have been executed so far to assess the benefits of the targeted fortification approach when compared to the standard approach currently adopted (see Fabrizio 2020 for a recent review). These studies allowed us to appreciate the potentiality of targeted fortification in improving the clinical outcomes for preterm infants.

While standard fortification poses the infants at risk of not getting the recommended intake, due to the lack of knowledge of the actual macronutrient content in the administered human milk, the targeted approach allows neonatologists to fortify the milk based on the actual milk content, which implies that the feeding given is tailored to the specific infants’ need.

Amongst the most promising results evidenced so far, infants fed with the targeted approach experience higher macronutrient intakes, higher weight gain and in general improved growth velocities for what concerns weight, length, and head circumference. They also show higher fat-free mass and less frequent feeding intolerance. Such results are due to a limited variation of macronutrient intake, which allows for a more balanced and constant diet. Infants get similar composition every day, avoiding the administration of lots of proteins or fat on one day, and less proteins or fat the other day, thus posing less stress on their premature gut and metabolism. Such outcomes have been recently linked to a reduced neonatal morbidity, in particular for what concerns the occurrence of NEC, sepsis and bronchopulmonary dysplasia (see Rochow 2020 and Sánchez Luna 2020). There is clearly the need to confirm those results, and above all quantify them, through specifically designed interventional trials. Meanwhile it’s not surprising that an increasing number of hospitals and neonatologists is implementing the targeted approach for managing the feeding of preterm infants.

But there is also the other side of the coin: compared to the standard approach, targeted fortification is more time-consuming, requires the purchase and maintenance of specific equipment for analysing human milk, and also trained staff for both operating the device and for calculating the fortification needed. Rochow 2015 estimated an average of 10-15 minutes per patient per day for applying this approach, which clearly raises the overall operational costs of the nursery.

In order to contain such costs and make the targeted approach sustainable in all nurseries, studies have been performed to assess the most cost-effective frequency of human milk analysis, trying to minimize as much as possible the macronutrient variation in infants’ feeding from day to day, but also reducing the workload for operators. For instance, Rochow 2015 suggested to perform human milk analysis “at least twice a week” as an optimal trade-off.
So, if we consider both benefits and costs, the big question is: is the targeted approach really cost-beneficial? To give an accurate answer, specific health economics studies are needed, where costs for implementation and maintenance of such an approach are compared to economic quantification of evidence-based benefits (for instance, savings generated by reducing the length of stay or key diseases, such as NEC).

Far from being an exhaustive article on this topic, we want here just to highlight a few available data aimed to provide a sense of the potential savings that could be generated by applying the targeted approach.

  • Reduction of length of stay. Several studies mentioned this potential benefit (see Rochow 2015), even if this has not been confirmed yet in the trials performed so far. The cost per hospitalization day varies from Country to Country, and even amongst hospitals in the same area. We take as a reference two studies performed by Johnson (2013 and 2015), where the average cost per hospitalization day of a VLBW infant was estimated respectively at $1,052 and $1,874. A hospital serving an average of 100 infants per year would therefore get significant savings even with just a 1-day reduction of the length of stay per infant (between $100,000 and $180,000).、

  • Reduction of parenteral nutrition. A more balanced diet in line with the targeted requirements may help in a faster switch from parenteral to enteral nutrition. Savings could be quite significant, if we consider that around $1,436 is spent daily per patient receiving parenteral feeding (Edwards 2012). In the use case of the previous point, savings per year could therefore reach around $143,000 in case of just 1-day reduction of parenteral feeding per infant.

  • Reduction of diseases during hospitalization. Since infants are fed with basically the same macronutrient composition over time, their gut works under more steady condition, and this is considered a factor for reducing the occurrence of specific diseases. This is going to be studied in upcoming clinical trials (see Seliga-Siwecka 2020), while other studies reported a reduction of specific diseases (see Sánchez Luna 2020). Let’s consider three diseases whose reduction has been mentioned in such studies: NEC, sepsis and bronchopulmonary dysplasia. The costs for those diseases have been reported in various studies. In Johnson 2015 reported an average total NICU hospitalization cost (in 2012 dollars) of $180,163 per infants with NEC and $134,494 for infants without NEC. NEC was associated with a marginal increase in costs of $43,818. Johnson 2013 reported that the presence of bronchopulmonary dysplasia was associated with a $31,565 increase in direct costs, and late-onset sepsis with a $10,055 increase. Any assumptions on the reduction rate would be completely arbitrary at this point, but imagine that just one case of each disease is avoided every year in a hospital. This will make savings up to more than $85,000 every year.

  • Long-term economic benefits. Savings in this area are clearly the most complex to be demonstrated and quantified, since they require the quantification of savings on clinical complications after hospitalization and on potentially life-long morbidities. One focus of the analysis could be related to the long-term benefits (and related savings) due to avoiding under- and over-nourishment caused by the standard approach. Another example is related to avoiding neurological impairment, due to optimal growth and to the reduction of infants’ morbidities during the hospitalization period. Let’s make a some reasonings related to the latter point.
    A key point is related to the “quality” of the weight gained during the hospitalization period. Parat 2020 showed that “targeted fortification of milk can influence the quality of weight gain through promoting fat-free mass in infants”, and early gain in fat-free mass has been demonstrated to generate positive long-term effects, unlike fat mass. Ramel 2016 demonstrated the association of fat-free mass at discharge with improved neurodevelopment in VLBW preterm infant at 12 months, while Scheurer 2018 showed that high percentage of fat mass is associated with lower-working memory performance in pre-school age (4 years). Another study (Frondas-Chauty 2018) demonstrated that a deficit of fat-free mass at discharge is associated with neurological impairment at two years of age.
    Neurodevelopment impairment has also been demonstrated to more likely occur in infants who had NEC or sepsis (diseases that the targeted approach could reduce) than in preterm infants without such morbidities (see Rees 2006 and Cai 2019). Conditions such as cerebral palsy, vision impairment or hearing impairment could be reduced thanks to the optimal growth promoted through targeted fortification, or indirectly by reducing the occurrence of diseases that make such impairment more likely in a later age. And their costs are not negligible. Honeycutt 2015 showed that lifetime costs per person for cerebral palsy are around $804,000 (in US$ 2000), for hearing loss at $325,000 and for vision impairment at $469,000. This gives us a sense of how large the life-long savings could be both for the society and for the patients.

So, a lot of work is still needed to precisely quantify the economic benefits of the targeted approach through evidence-based studies, but the more our knowledge advances in this field, the more targeted fortification seems to provide promising results.

We therefore want to conclude this blog by mentioning Sánchez Luna 2020. The study reports the benefits coming from the establishment of a personalized nutrition unit (PNU), based on a smart management of mother’s milk and the application of targeted fortification. This approach led to “a significant reduction of NEC in preterm infants of < 32 weeks of gestation, from 10.9% (12/110) to 2.4% (2/84), and late-onset sepsis from 14.7 cases/1,000 days of central lines to 9.5 cases/1,000 days of central lines, with a shorter use of central venous catheters for parenteral nutrition and a better growth during hospitalization”.

We are firmly convinced that similar studies and their promising results will multiply in the near-future, not only evidencing the unique clinical benefits that the targeted approach can guarantee to preterm babies, but also demonstrating that the approach is sustainable and economically beneficial in both the short and long term. The path seems really to be market out, and Preemie is proud to give its contribution to this radical change.


REFERENCES

Fabrizio 2020 – Fabrizio V, Trzaski JM, Brownell EA, Esposito P, Lainwala S, Lussier MM, Hagadorn JI. Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD013465. DOI: 10.1002/14651858.CD013465.pub2.

Rochow 2020 – Niels Rochow, Gerhard Fusch, Anaam Ali, Akshdeep Bhatia, Hon Yiu So, Renata Iskander, Lorraine Chessell, Salhab el Helou, Christoph Fusch. Individualized target fortification of breast milk with protein, carbohydrates, and fat for preterm infants: A double-blind randomized controlled trial. Published by Elsevier Ltd. 2020, https://doi.org/10.1016/j.clnu.2020.04.031.

Sánchez Luna 2020 – Manuel Sánchez Luna, Sylvia Caballero Martin, Carmen Sánchez Gómez-de-Orgaz. Human milk bank and personalized nutrition in the NICU: a narrative review, European Journal of Pediatrics, 2020, https://doi.org/10.1007/s00431-020-03887-y

Rochow 2015 – Niels Rochow, Gerhard Fusch, Bianca Zapanta, Anaam Ali, Sandip Barui and Christoph Fusch. Target Fortification of Breast Milk: How Often Should Milk Analysis Be Done?, Nutrients 2015, 7, 2297-2310; doi:10.3390/nu7042297

Johnson 2013 – Tricia J. Johnson, Aloka L. Patel, Briana J. Jegier, Janet L. Engstrom, and Paula P. Meier. Cost of Morbidities in Very Low Birth Weight Infants. THE JOURNAL OF PEDIATRICS, Vol. 162, No. 2, 2012. DOI:https://doi.org/10.1016/j.jpeds.2012.07.013

Johnson 2015 – Tricia J. Johnson, Aloka L. Patel, Harold R. Bigger, Janet L. Engstrom, and Paula P. Meier. Cost Savings of Human Milk as a Strategy to Reduce the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants. Neonatology. 2015 ; 107(4): 271–276. doi:10.1159/000370058

Edwards 2012 – Taryn M. Edwards, Diane L. Spatz. Making the Case for Using Donor Human Milk in Vulnerable Infants. Adv Neonatal Care. 2012 Oct;12(5):273-8; quiz 279-80. doi: 10.1097/ANC.0b013e31825eb094.

Seliga-Siwecka 2020 – Joanna Seliga-Siwecka, Anna Chmielewska and Katarzyna Jasińska. Effect of targeted vs standard fortification of breast milk on growth and development of preterm infants (≤ 32 weeks): study protocol for a randomized controlled trial. Trials (2020) 21:946 https://doi.org/10.1186/s13063-020-04841-x

Parat 2020 – Sumesh Parat, Praneeta Raza, May Kamleh, Dennis Super and Sharon Groh-Wargo. Targeted Breast Milk Fortification for Very Low Birth Weight (VLBW) Infants: Nutritional Intake, Growth Outcome and Body Composition. Nutrients. 2020 Apr 21;12(4):1156. doi: 10.3390/nu12041156.

Ramel 2016 – Sara E. Ramel, Heather L. Gray, Ellen Christiansen, Christopher Boys, Michael K. Georgieff, and Ellen W. Demerath. Greater Early Gains in Fat-Free Mass, but Not Fat Mass, Are Associated with Improved Neurodevelopment at 1 Year Corrected Age for Prematurity in Very Low Birth Weight Preterm Infants. J Pediatr. 2016 Jun;173:108-15. doi: 10.1016/j.jpeds.2016.03.003. Epub 2016 Apr 4.

Scheurer 2018 – Johannah M. Scheurer, Lei Zhang, Erin Plummer, Solveig Hultgren, Ellen W. Demerath, Sara E. Ramel. Body Composition Changes from Infancy to 4 Years and Associations with Early Childhood Cognition in Preterm and Full-Term Children. Neonatology 2018;114:169–176 DOI: 10.1159/000487915

Frondas-Chauty 2018 – Anne Frondas-Chauty, Laure Simon, Cyril Flamant, Matthieu Hanf, Dominique Darmaun, and Jean-Christophe Rozé. Deficit of Fat Free Mass in Very Preterm Infants at Discharge is Associated with Neurological Impairment at Age 2 Years. J Pediatr. 2018 May;196:301-304. doi: 10.1016/j.jpeds.2017.12.017.

Rees 2006 – Clare M Rees, Agostino Pierro, Simon Eaton. Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed 2007;92:F193–F198. doi: 10.1136/adc.2006.099929

Cai 2019 – Shirley Cai, Deanne K. Thompson, Peter J. Anderson, and Joseph Yuan-Mou Yang. Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis. Children (Basel). 2019 Dec; 6(12): 131. doi: 10.3390/children6120131

Honeycutt 2015 – Amanda A Honeycutt, Scott D Grosse, Laura J Dunlap, Diana E Schendel, Hong Chen, Edward Brann, Ghada al Homsi. “ECONOMIC COSTS OF MENTAL RETARDATION, CEREBRAL PALSY, HEARING LOSS, AND VISION IMPAIRMENT” In Using Survey Data to Study Disability: Results from the National Health Survey on Disability. Published online: 10 Mar 2015; 207-228.

Challenges and opportunities in managing infant feeding in NICUs

Whoever had the chance to access and move around in a Neonatal Intensive Care Unit knows how precious and extremely difficult the work of neonatologists and nurses is. Those tiny little babies are there, suffering, crying, their lives hanging by a thread, and your heart constricts at their sight, making you feel powerless. But doctors out there are not, and they fight every day to give those babies the chance to survive, to defeat prematurity and other diseases, to grow fast and thrive.

In such an emergency situation, whatever can be made which facilitates and supports their work, is not simply just an improvement into their daily workflow, but can have a huge clinical impact; it means that they have more time to focus on the care of their infants and on clinical decisions.

Therefore, more than in any other healthcare application, whatever improvement in efficiency of the workflow, support in data collection, visualization and analysis, and in healthcare delivery, can turn into improving clinical outcomes and even saving lives.

Since the very start of designing the Preemie System, we interacted with several neonatologists, paediatric dietitians, and nurses, and analyzed with them how our solution could improve their work, leveraging the possibility of rapid human milk analysis as well as the power that digitalization can offer in easing data collection, processing and analysis.

We want to point out some examples of how a fully digital approach can add value in managing infant feeding, not only by saving time (and money, of course), but also supporting healthcare professionals in their clinical decision-making process.

High level of flexibility to meet specific requirements

When it comes to feeding preterm infants, a clinical decision has to be made taking into account several factors, including the clinical history of the infant, the growth rate over time, and the amount of feeding administered over time.

Many other factors play a role which are dependent on the peculiar approach to fortification that the NICU has put in place in its protocol. It’s not just the approach being based on either standard, adjusted or targeted fortification, but also boundary conditions such as the guidelines with reference ranges for the fluid and macronutrients intake, or the selection of specific fortifiers which are being used in the hospital.

In order to track in a granular way what is actually being administered to the infant, all this data has to be taken into account, and a flexible digital system can allow any kind of customization in this sense. Not only the doctor could select customized guidelines for specific subgroups of infants, as well as use different fortifiers with all reference data being stored automatically. Customization can also span over more subtle features, where research is always ongoing and there is still lack of official guidelines.

An example is the estimated level of absorption of the macronutrients administered through enteral nutrition. By means of customizable settings to define such levels, based on the latest research and on neonatologists’ experience, doctors can make the most out of data when prescribing and monitoring the feeding, without the need to make any calculation. The system can track automatically how much milk and fortifiers have been prescribed, the amount of macronutrients that are going to be delivered, how much out of them it is estimated that the infant will actually absorb, as well as the actual amount of milk that the infant got against the milk prescribed.

Provide data insights to support clinical decisions

The amount of data collected is of high value when doctors make feeding decisions. Despite the need for standard protocols for properly managing infants’ health, healthcare delivery is more and more going towards a personalized approach, which ensures more effective clinical outcomes. Feeding management makes no exception, and such personalization has to firmly rely on key indicators based on data collection and analysis. Digital tools have the power to provide doctors with such indicators at a glance, through meaningful and easy-to-read visualizations. They enable us to compare growth and feeding over the last days, how much nutrients have been actually administered to the infant against the prescription, which fortifiers are providing the best outcomes, and therefore support doctors to make more informed decisions based on the infant’s health status.

Here is where technological innovation can play a crucial role, allowing specialists to collect data which makes personalization truly possible. This is the case of the Preemie Sensor, which allows doctors to analyse human milk and take into account the actual macronutrients content when calculating the fortification and the overall nutrition to be administered.

This is a fundamental step towards personalized healthcare, since now it is possible to exert accurate control over what is being administered, without relying on assumptions and average values in milk content.

Automatization, whenever possible

This is mostly about saving time and costs, and at the same time preventing the potential occurrence of human errors. Digital tools shall replace paper-based or spreadsheet systems, which are time-consuming and prone to errors, and support professionals in both basic and more complex calculations.

As an example, based on the guidelines selected and the weight of the infant, the system can immediately indicate the suggested range of fluid and macronutrient intake, to be considered as reference values by the doctor. More importantly, based on the real values of the milk content and the fortifiers used, the system can easily calculate and display the amount of macronutrients provided to the infant, thus enabling the doctor to tweak the target values of each macronutrient, and provide in output the related amount of fortifiers to be added. The system is thus able to support the users in each operation during the entire workflow, streamlining the calculation and the prescription process, and moreover making it possible to perform each operation anytime and anywhere.

As an example, the milk can be analysed in the human milk bank, and data are automatically stored in the system. Few hours later, the doctor can use the very same values to calculate the fortification and make the prescription in the office, and the prescription is then available in real time to the nurse at the NICU for her to actually fortify the milk and administer the prescribed feeding.

Blogpost-2021May_3

Metadata for empowered support

Maybe we are going too far, but every innovation must be inspired by a long-term vision. We know that nothing can replace the competence, sensitivity and experience of medical doctors, and that every innovation in the healthcare sectors shall be thoroughly tested and validated through clinical trials and scientific debate.
But at the same time, we are firmly convinced that the collection and use of big data and the application of disrupting technologies such as Artificial Intelligence can really empower healthcare professionals and support them in clinical decision-making.

Just imagine if doctors could tap into a huge database of clinical records (anonymized, of course), and when taking a decision (be it the choice of a fortifier, the amount to be used, or the amount of milk to be prescribed) display in real-time clinical records of a cohort of infants with a clinical history similar to the patient (e.g. gestational age, growth history, comorbidities), and thus know which choices from other doctors led to the desired outcomes and which did not.

Maybe it’s planning too far ahead, but we believe that such approaches will really revolutionize both research activities and clinical practice in the forthcoming future.

This is a step-by-step process, which involves embracing digital transformation and continuously finding innovative solutions, and we sincerely hope that the Preemie System will contribute to this challenging journey.

The value of a fully digital approach in Human Milk Banks

Digital transformation, especially in this period of global pandemics, has become a fundamental factor to improve processes, efficiency and productivity in all kinds of industrial sectors. Healthcare makes no exception, and can now leverage innovative technologies able to drastically impact the quality of services provided to patients, such as Artificial Intelligence (AI)-enabled medical devices, or the application of blockchain technology to electronic health records, just to mention a few.


The use of digital tools can also significantly improve the way healthcare providers work, streamline and simplify their workflow, and finally enable them to focus more on what is most important in their mission, their patients’ care.

Narrowing down to human milk and feeding management for hospitalized term and preterm infants, few challenges apply. We know the extraordinary work that both Neonatal Intensive Care Units (NICUs) and Human Milk Banks (HMBs) perform every day to save infants’ lives and ensure they get all the nutrition they need to thrive. Innovative tools can support them in their daily work, not only providing new ways to personalize patients’ care, but also to automate, and therefore simplify operations, save time and costs, and avoid potential errors.

Unfortunately, NICUs and HMBs in Europe have different levels of digitalization, ranging from highly automated software systems to a poorly integrated mix of different tools, including dedicated software programmes, generic spreadsheet software such as Microsoft Excel, and paper-based records. One of the main issues is that each NICU and HMB has a specific procedure for managing human milk, collecting and storing the milk in the freezers, testing the milk for bacterial load, calculating the fortification needed for the infants, and so on. Digitalizing such variability of processes and improving their effectiveness through dedicated software requires a certain level of customization. This explains why NICUs and HMBs often use software solutions designed or even developed internally, or still exploit paper-based approaches or Excel files to record operations and calculate milk fortification.

We firmly believe that process automation through a dedicated end-to-end software solution like Preemie’s can bring several advantages, by reducing at the bare minimum human operations that waste time and generate errors (e.g. feeding an infant with the wrong milk, errors in calculating the milk fortification for the infant), and at the same time speeding up processes, especially when handling and processing human milk.

After having interacted with a large number of both NICUs and HMBs in Europe, it is worth to outline just a few examples of how digitalization could generate value. They don’t mean to be exhaustive, of course, but just to provide a sense of how a dedicated software solution can impact at different levels. These examples are related to the way HMBs manage the milk from reception to delivery, manage the processes at the HMB and the related data generated.

Control over the expiration date of the milk

This seems a simple operation, but still HMB operators in some cases do it visually by checking the bottles in the freezers. An automated way to infer such information in the software could prevent HMBs from losing expired milk, but also help them in selecting which milk should be delivered first to avoid aging.

Milk logistics

Store and know the position of the milk, easily retrieve the milk, select the milk to be delivered based on specific factors (age, donor, type of milk): all such operations can be streamlined through the applications of filters in the software to select the most suitable milk to be prepared and also to identify where the milk has been stored in the freezer and in the related compartments, thus saving time for the operator.

Administration work

Keeping track of the milk history seems to be one of the most time-consuming operations at the HMB. Registering the milk and its source, managing and storing the different batches received over time and how they are processed (pooling, thawing, pasteurizing, etc.), recording and managing requests for milk coming from hospitals, keeping track of milk prepared and delivered: they are just a few operations that require time and efforts for being recorded and tracked over time. All of them can be managed digitally, through software solutions that enable fast data entry, and above all keep all data recorded and readily available in case the operator needs to access whatever information – for instance, the milk batches that need to be pooled, the list and features of milk requested by hospitals, and so on. This also enables operators to be more focused on the actual operations to be performed on the milk, with less distractions for administrative work that could lead to milk contamination or mistakes.

Matching milk type and recipient

Milk’s content varies depending on various factors that can be tracked, including the fact of being term or preterm milk, single donor’s milk or pooled milk. Each HMB and NICU manages differently the milk based on such features. For instance, some HMBs do not pool milk while others do, others try to administer only colostrum-like milk to very fragile infants, while others provide milk to hospitals mainly based on logistics issues. In some cases, operators write down manually information about the milk on the bottle or in paper registries, which makes very time-consuming for them to retrieve the milk which matches specific recipients. An automated solution could easily support them in milk selection or even suggest this match based on pre-set instructions.

Tailored pooling

This is a more sophisticated example of how digitalization and innovative technologies can drive a step change in how neonatologists work and personalize care. After having analysed the milk received from donors by using the Preemie sensor, our system can suggest which milk batches should be pooled in order to reach certain levels of macronutrients (for instance, high or low protein levels), so as to match the specific needs of an infant. Needless to say, every operator and neonatologist we spoke was enthusiastic about this.

Clearly, similar examples can be mentioned in relation to the activity in the NICU, and also in the way NICUs and HMBs interact. In a following blog article, we will analyse in more detail how a digitalized approach can help neonatologists and nurse in calculating milk fortification, as well as parenteral and enteral nutrition, and how a fully integrated system can facilitate interactions between NICUs and HBMs, streamlining operations, enhancing transparency and traceability, and finally improving patients care.

Preemie Sensor Wins Gold and Silver Awards from the International Design Awards (IDA)

The Preemie Sensor human milk analyser unique and simplistic design puts this medical device into a category of its own!


London, United Kingdom February, 2021 – We are pleased to announce that Preemie Sensor has received two awards for its beautiful, ergonomically friendly design from the 14th Annual Edition of the International Design Awards (IDA) within the Children’s Product Category. A Gold prize winner in the Pregnancy and Maternity and a Silver prize winner in the Health and Baby Care.

When we were first approached to design a medical device that would analyse breast milk, we challenged ourselves to do something different. We wanted to create something extraordinary that went beyond complicated medical interfaces typically seen in healthcare. This is why we think the colour, size, texture and simplicity in design resonates not only with the IDA Jury but with professionals within the industry as well.

– Massimiliano Datti and Alessandro Spalletta, Preemie Industrial Design Team – 

This year IDA received thousands of submissions from over 80 countries in 5 primary design categories: Architecture, Interior Design, Graphic Design, Product Design, and Fashion Design. The international Jury evaluated the entries and sought out designs beyond the ordinary, seeking those that reflected the revolutionary leading the way into the future.

“The IDA seeks out truly visionary designers showcasing creativity and innovation. As the world struggled with an unprecedented challenge in 2020, the IDA received a record number of outstanding entries which presented the Jury with an enormous task in selecting the winners,” commented Jill Grinda, VP Marketing and Business Development as stated in the IDA press release.

Receipt of this internationally celebrated award comes within months of the Preemie Sensor garnering the prestigious German Design Award in the category of Medical, Rehabilitation and Healthcare

“When developing the Preemie sensor, we wanted to keep the functionality and configuration as user friendly as possible. Its simplistic design makes it easy to use for NICUs and Human Milk Banks professionals.” Remarked Isabel Correa, CEO and Founder of Tellspec LTD. “There is nothing else like it on the market; the Preemie system is the  first complete platform for the management of preterm feeding. We are honoured by the recognition given to us by the IDA Jury.”

The Ultimate Preemie and Mom Reference Guide

Links to websites that inform, inspire, support, advocate, educate and feed the soul.


There is a tremendous amount of information on the web. Trying to learn more about your preemie baby can be overwhelming, so we created this list so you don’t have to. We tried to include links to sites that we felt would benefit you and your preemie.  

If you want to add to this list, please email us at info@preemiesensor.com; after all, sharing is caring, and knowledge is power!

ABOUT PREEMIES

We focused on publications that provide a section within their website dedicated to preterm babies.

FOR MOM’S

A shortlist of resources to support the mind, body and soul as you take care of your newborn preemie.

  • Motherly an online community that inspires and connects.
  • Today’s Parent provides you parenting, baby, pregnancy and family insights through real-life stories and expert advice. 
  • Absolutely Mama designed for the modern mom who wishes to forge her own path, filled with great insights and advice on parenting, lifestyle and fashion.
  • Mother&Baby covers every aspect of being a mom from pregnancy to baby to toddler.
  • Mother Magazine is designed to provide stories, lifestyle and health information for the modern mom.
  • Very Well family is a catch-all site with content ranging from stories to activities to online tools covering all aspects from pregnancy to raising healthy kids of all ages and stages to the latest news.
  • Hand to Hold “You are not alone” This site provides a soft and gentle approach. They offer a one-on-one peer mentoring program, along with blogs, podcasts, social networks and resources for in-hospital programs for NICU families, Bereaved Families and NICU professionals.

BREASTFEEDING SUPPORT

HUMAN MILK BANKS

Sometimes mothers cannot provide their own milk to their newborns, and the reasons vary from not producing enough milk to physically being unable to breastfeed due to illness. Human milk banks operate to help provide the milk required to help babies grow, especially vulnerable low birth weight infants. If you have breastmilk to spare, please #donate it to your local human milk bank.

Locate your human milk bank within your country. Please note that some milk banks are located within the hospital itself.

Austria, Belgium, Brazil, Bulgaria, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Holland, Hungary, Ireland, Italy, Lithuania, Netherlands, Norway, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Spain, Sweden, and Switzerland.

For additional information and resources on human milk, please visit PATH organisation, a global non-profit that improves public health.

ORGANISATIONS AND AGENCIES

These initiatives focus on helping communities worldwide by addressing the issues around preterm births, conducting research and providing guidelines that advocate for change. You can support these organisations through donations as well. 

 

An overview of the research article on ‘Human milk bank and personalized nutrition in the NICU: a narrative review’

Originally published in the European Journal of Pediatrics, November 27, 2020. “This narrative review presents salient data of our current knowledge and concerns regarding milk feeding of preterm infants in the NICU, with special emphasis on personalized donor milk as a result of establishing a Personalised Nutrition Unit (PNU).” Written by Manuel Sánchez Luna, Sylvia Caballero Martin and Carmen Sánchez Gómez-de-Orgaz.


Today approximately 15 million babies are born prematurely and is ‘the leading cause of mortality among children aged under five years, with a majority of deaths due to preterm birth occurring in the neonatal period.

Nutrition is Key

To fight this problem, appropriate nutrition is a critical element in improving preterm babies’ survival and outcomes. Sometimes, instead of the mother’s own milk (MOM), donor milk (DM) from a similar gestational and lactation stage is given. This milk, provided by human milk banks (HMB), is composed of pooled term milk at various lactation stages. In some instances, they are far from having the characteristics of the MOM. In these circumstances, personalised fortification using DM is the ideal approach to feed preterm infants.

Preterm Milk Composition

A contributing factor for growth failure in preterm infants is low protein intake. Studies have shown that the mother’s milk of premature infants has significantly more protein, nitrogen, and amino acids during the first weeks of lactation. This unique combination of nutrients of the preterm milk properties contributes to the premature infants’ rapid growth rates. Also unique to breastmilk are human milk oligosaccharides (HMOs), which are known to be a strong protection for necrotizing enterocolitis (NEC). It is essential to state that the breastmilk’s pasteurization does not affect HMO content and that no differences were found between unpasteurized and pasteurized human milk for any or severe NEC.

Personalised Fortification

Currently, 20% of donated breastmilk comes from mothers of preterm infants. In Brazil, a leader of human milk banks, 44% of their donors are mothers of preterm infants, and if the mother’s milk nutritional requirements are not met, then donor milk is often given to babies. In both cases, MOM or DM, personalised fortification is performed inside NICUs. A significant reduction in NEC and late-onset sepsis was correlated with the usage of personalized fortification. Due to the personalized fortification, a shorter use of central venous catheters for parenteral nutrition, which is the administering of nutrition intravenously and better growth during hospitalization was also associated with this.

Conclusion

Mother’s own milk is the healthiest and most convenient way of providing the essential nutrients to newborns. If the mother cannot provide her breastmilk, donor milk is a good alternative. On the other side, and as the milk composition varies with gestational age and stage of lactation, personalised feeding using donor milk from mothers with preterm infants, combined with personalised targeted fortification, is the optimal approach.

We would like to thank Dr. Manuel Sánchez Luna, Professor Neonatology Division Hospital Materno Infantil Universitario Gregorio Marañón, Madrid, España for his continued research on personalized donor milk working towards the establishment of in the development of a personalized nutrition unit within hospitals in Spain. You can follow Dr. Luna on Twitter @manutoronto13

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!

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