The research team at UHS is supporting the delivery of the world’s largest trial into treatments for patients hospitalised with COVID-19. Almost 100 patients recruited in Southampton The randomised control trial, known as RECOVERY, aims to compare usual care to several different treatments, including a commonly used antibiotic and plasma from those who have recovered from the virus. To date, the research team has recruited almost 100 patients to take part. It has been a real team effort, with the Trust’s dedicated research team working closely with colleagues on the wards delivering patient care. Across the UK, more than 25,000 participants have been recruited across 176 sites. Finding life-saving treatments The trial, which is running in all UK acute trusts, has already changed clinical practice, identifying the commonly used steroid dexamethasone as the first drug to improve survival rates in certain coronavirus patients. As coronavirus cases continue to rise, research teams across the UK are encouraging colleagues to ask their COVID-19 patients about taking part in the trial to help get more answers about which treatments improve outcomes for patients. Dr Sophie Fletcher, a Consultant Respiratory Physician at the Trust who leads the trial locally, said: “We are incredibly proud of our Trust’s commitment to delivering this important research trial. “To have recruited almost 100 participants is a phenomenal achievement and a tribute to the hard work of colleagues at the Trust, who have been able to work at pace to ensure as many people as possible have the opportunity to take part and try potential treatments against this disease.” Support the trial Dr Fletcher added: “Findings from the RECOVERY trial are saving lives and changing practice globally. As cases increase, we want to raise awareness of this important trial, so that more patients have the opportunity to take part.” To support the trial, talk to the Trust’s R&D department or visit: www.recoverytrial.net This trial is supported by a grant to the University of Oxford from UK Research and Innovation/National Institute for Health Research (NIHR) and by core funding provided by NIHR Oxford Biomedical Research Centre, Wellcome, the Bill and Melinda Gates Foundation, the Department for International Development, Health Data Research UK, the Medical Research Council Population Health Research Unit and NIHR Clinical Trials Unit Support Funding.

A Singapore study with the NIHR Southampton BRC has shown that parents’ TV viewing habits are the strongest behavioural predictor of toddlers’ excessive time in front of TV and handheld screens, posing a risk to their development and health. NIHR Southampton BRC nutrition theme lead Prof Keith Godfrey was part of the study team that looked at factors influencing screen viewing time, amongst two and three year olds. Published in the International Journal of behavioural Nutrition and Physical Activity, it closely monitored 1247 pregnant mothers and 1171 toddlers born from 2009 onwards. Health risks of sedentary viewing The low physical activity and social interaction involved in long periods of time spent in front of screens has long been associated with impacts on mental and physical health. Some of these effects in pre-schoolers include eating disorders, sleep deprivation and developmental delays, and greater risk of developing obesity. Parental influence The new study considered mothers’ ethnicity, family income, education, age, BMI and other factors. It found that the children of younger mothers, of lower than university degree education level, or Indian and Malay ethnicity, spent longer in front of screens. However it was mothers’ daily television viewing habits that were the strongest behavioural predictor of their child’s total screen time. The research found that when the mother watched more than 2-3 hours of TV daily, their children spent more time in front of screens than when the mother watched less TV. Evidence for changing behaviours These findings add weight to previous studies showing that the presence of frequent screen users within a household is often associated with a child’s screen behaviours. It provides evidence suggesting that interventions aimed at changing parental viewing behaviours could be beneficial in tackling poor health outcomes associated with excessive screen time amongst young children.

If you’ve ever blown your nose at an underground station, you’ll be familiar with the black dust it harbours. New research from our BRU shows this dust can get inside lung cells and may aggravate conditions like asthma. Southampton researchers have shown that black dust taken from an underground railway station in the Netherlands can cause lung inflammation, increasing the risk of triggering an asthma attack. Not just harmless dirt Black dust found at underground railway stations, more formally known as ‘particulate matter’, is a major health concern. It is estimated that, on average, it reduces the life expectancy of each person in Europe by almost a year. The study, published in Toxicological Sciences, involved researchers in Southampton and the Netherlands. It found particulate matter can get deep inside lung cells and set off an inflammatory response, adding to a growing body of evidence showing this dust could be harmful to our health and may be particularly dangerous for those with an existing lung condition. Breaching the barrier The researchers collected the dust from a major railway station in the Netherlands. The station lies in the middle of a 5.1km long tunnel under an airport, and is used by around 60,000 passengers every day, reaching 150,000 at weekends. When they added this dust to lung lining cells grown in the lab, they saw the dust particles become deeply lodged within the cells. This was still the case when the cells were coated with the lungs’ protective mucus layer, which normally acts as a barrier to catch any dirt and debris we breathe in. While plenty of dust particles got stuck in the mucus, as they do in your snot, some still got through. Once inside the cells, the dust particles caused the lung cells to produce inflammatory compounds - a distress call to the immune system. If this occurred in a person, it could cause their airways to swell up and narrow, with potentially serious consequences in an asthmatic. Dangerous dust Whereas dust normally contains very little metal, the black dust at an underground station has an unusually high iron content. The researchers demonstrated it was this that caused the lung cells to react as they did. In this way, they not only showed that particulate matter from an underground station could pose a threat to someone with a lung condition, but also demonstrated the mechanism by which lung inflammation could occur, explaining how this apparently innocuous back dust can harm our health.

Doctors in Southampton are trialling a new tablet that could reduce the effects of allergic asthma in children with a house dust mite allergy. The study, that’s taking place in the NIHR Southampton Biomedical Research Centre, will see children with allergic asthma taking a tablet that contains a small dose of house dust mite. It’s hoped this will teach their bodies to accept it and trick their immune system to not cause a reaction. “The tablet is very safe, with little to no long-term side effects, and has a good track record in older patients,” explained Professor Graham Roberts who is leading the study and is a specialist in paediatric allergy and respiratory medicine at University Hospital Southampton NHS Foundation Trust. “Exposing children with allergic asthma to a small dose of whatever they are allergic to can reduce their body’s reaction to the trigger. This will, in turn, reduce the likelihood of asthma attacks and further problems in the future.” Treating asthma Allergic asthma is caused when a person has an allergic reaction to one or more triggers, such as dust mites and animal fur. Triggers cause exacerbations, or asthma attacks, that cause the airway to become swollen and inflamed, making it increasingly harder to breathe. Asthma is usually treated with a blue inhaler to alleviate symptoms of wheeziness when an attack occurs, alongside a daily brown, purple or orange inhaler to stop the symptoms of wheezing developing. Inhalers are often a successful treatment for most patients but may not be as effective in patients with allergic asthma as the treatment requires doctors to identify and deal specifically with the trigger that causes attacks. Using immunotherapy Immunotherapy is a type of treatment that involves giving patients a gradually-increasing dose of a substance, or trigger, to which someone is allergic. Slowly increasing doses of the trigger causes the immune system to become less sensitive to the substance. As the body becomes more exposed to the trigger, it produces more antibodies – which reduce the symptoms of the allergy when the substance is encountered in the future. For this study, the trigger is the dust mite and participants will take a daily tablet that contains a small amount of house dust mite, in the hope it will reduce the body’s reaction to the trigger. Transforming treatment In a previous study looking at adults with house dust mite allergic asthma, the tablet produced positive results and showed the number of exacerbations and hospital visits reduced for each patient. Professor Roberts hopes for similar results in his study, explaining that: “Children’s asthma is a very different condition, and just because the tablet worked in adults doesn’t mean we can assume it will work in children too. “We expect the treatment to work well, and given the tablet’s previous successes, we are hopeful that we can demonstrate the benefits of immunotherapy for children through this trial.” Getting involved Professor Roberts’ study is looking to recruit around 20 children to take part over the next 18 months. In order to take part, the child must be aged 6-16, living with asthma and using a regular inhaler every day. The study will involve monitoring for the next 18-24 months.

The University of Southampton NHS Foundation Trust (UHS) and University of Southampton (UoS) partnership are inviting expressions of interest for the role of Theme Lead for the NIHR Southampton BRC Theme Lead in i) Respiratory and Critical Care Medicine and ii) Nutrition, 2022-2027, subject to Southampton being awarded a BRC from 2022. Successful applicants will act as theme lead designates during the preparations for the NIHR Southampton BRC 2022-2027 competition, and subsequently as theme leads, subject to the relevant theme being awarded as part of an overall successful application for a BRC from 2022. Post holders will be appointed for 30 months fixed term contract, renewable for a further 30 months subject to the agreement of the UHS/UoS Partnership (total 5 years). Applicants should be a senior clinical academic with national/international standing as a leader in their field, with knowledge and experience of experimental medicine. Applicants should demonstrate: sustained record of excellence in research activities as indicated through high impact publications and citations in experimental research. experience interdisciplinary and collaborative working within and beyond Southampton track record with working with industry and other research institutes to generate external income. sustained record of excellence in teaching and learning activities in experimental medicine experience of patient involvement/engagement activities related to experimental medicine. NIHR Biomedical Research Centres Formed through partnerships between England’s leading NHS organisations and universities, NIHR Biomedical Research Centres (BRCs) conduct experimental research to transform scientific breakthroughs into life-saving treatments for patients. Staffed by expert investigators and clinicians, NIHR BRCs are leaders in translating lab-based discoveries into new cutting edge treatments, technologies, diagnostics and other interventions in clinical settings. The aims of NIHR BRCs are to: drive innovation in the prevention, diagnosis and treatment of ill-health translate advances in biomedical research into benefits for patients provide a key component of the NHS contribution to our nation’s international competitiveness by making the best Centres even better. NIHR Southampton BRC The NIHR Southampton BRC 2022/23-2026/27 will build on the success of the previous award and thus applications for the Theme Lead role will be open to current theme leads and senior researchers engaged with the current BRC. The Theme Lead will be appointed to lead the application for their theme and contribute to the overall BRC application for the next NIHR funding application, working closely with the BRC director designate. Expressions of interested should be made through submission of an up to date curriculum vitae (CV) to mandy.fripp@uhs.nhs.uk. The deadline for submissions of expressions of interest is 10th September 2020. We welcome informal discussion regarding the role, for further information please contact Professor Mike Grocott, Director Designate between 1st September and 9th September 2020. Expressions of interest will be shortlisted. An interview will be scheduled for shortlisted applicants. Job description and person specification

Southampton consultant anaesthetist and researcher Professor Mike Grocott is taking on the 2020 London Marathon, raising money to train anaesthetists in Africa. With 95 days to go, he’s putting himself through the same training that his team’s research has shown enables cancer patients to get fit for surgery – shrinking their tumours, improving their recovery and boosting their quality of life. On Sunday, 26 April, Professor Grocott will be pounding the streets of London, raising money to train anaesthetists across Africa. Unlike the UK where there are 18 anaesthetists for every 100,000 patients and death due to anaesthesia is rare, surgery and childbirth in many African countries is much more risky, with less than 0.18 anaesthetists per 100,000 people in some cases. Advancing anaesthesia Professor Grocott’s fundraising for Safer Anaesthesia from Education (SAFE) through the Association of Anaesthetists (see link below) will help fund three-day training courses for doctors and non-doctor anaesthetists, who will go on to treat 1,500 patients a year and be able to train colleagues themselves as a result of the training. “This is particularly important for the care of women around the time of childbirth and for young children, who do not have access to the sort of safe care that we all take for granted in the UK,” explains Professor Grocott. As vice-president of the Royal College of Anaesthetists, the marathon challenge reflects Mike’s commitment to advancing anaesthesia and supporting anaesthetists’ professional development. It also mirrors the experience of cancer surgery patients who have benefited from being part of his team’s ground-breaking research. “14 weeks to train is less than the recommended 20, but I can’t complain as it’s more than many of the cancer patients in our studies have to train for the gruelling challenge of major surgery,” adds Professor Grocott. Following in participants' footsteps Those ‘prehabilitation’ studies have shown that high intensity exercise can completely reverse the damage chemotherapy does to patients’ physical fitness by the time they enter the operating theatre. They’ve also shown that this exercise shrinks tumours, improves patients’ wellbeing and quality of life and aids recovery. “I think it’s great Mike is doing this. SAFE is about getting the basic, critical things right for patients and, ultimately, that’s what our prehabilitation work is about – it’s as simple as making sure people are in the best possible shape before major surgery,” comments Professor Sandy Jack, lead for the prehabilitation studies at Southampton. That work has grown through the WesFit Trial, which sees cancer surgery patients receive either exercise training, psychological support or both together. Designed to test the approach across with larger numbers of patients, WesFit started as a regional project but is now drawing in most of the UK. “We’ve seen massive appetite from nearly all of the regional NHS Cancer Alliances, with Plymouth the latest site to join. What’s key is that we’re partnering with gyms to deliver the exercise sessions, and cancer charities for the psychological support – it’s closer to home, more accessible and more likely to lead to lifelong activity and wellbeing,” Professor Jack adds. “Ultimately, we want to do the best for patients – whether that’s by improving care through research or by helping our colleagues overseas get the training they need,” adds Professor Grocott. Donate today Mike aims to raise £2,500 for SAFE and donations can be made through his fundraising page. For more information on the to Association of Anaesthetists SAFE Africa campaign, click here.

Southampton researchers have found boosting a key part of the body’s immune system has the potential to prevent viral infections in patients with lung diseases. Researchers from University Hospital Southampton NHS Foundation Trust and the University of Southampton, in collaboration with the biopharmaceutical company AstraZeneca, have shown that interferon beta (IFN-β) could help protect lung disease patients against viral infections. Promising results IFN-β is a key part of the body’s natural immune defence against viruses, and is already used to treat patients with the relapsing-remitting form of multiple sclerosis. The results from this study – carried out in a laboratory and published in the American Journal for Respiratory and Critical Care Medicine – showed that IFN-β protected cells taken from patients with chronic obstructive pulmonary disease (COPD) protect against a flu virus. However, applying IFN-β to the cells after they had been infected did not help, so any treatments using IFN-β would need to be preventative. While this research is still in the early stages and more in-depth investigations are needed, this initial study suggests that IFN-β has the potential to prevent viral infections in lung disease patients. Immune boost Lung infections can cause worsening of symptoms, known as exacerbations or flare-ups, for patients with asthma and COPD. This research suggests that giving IFN-β to COPD patients could prevent flare-ups caused by viral infections, by boosting their body’s natural immune defences. Professor Tom Wilkinson, consultant in respiratory medicine in Southampton and study lead, said: "Respiratory infections lead to around four million deaths per year and have an enormous impact on global health. “Viral infections in patients with asthma and COPD can lead to worsening of symptoms and disease progression through exacerbations. “These latest results provide important insights to aid the optimal design of future clinical trials of IFN-β and related therapies in both asthma and COPD.”

Women who lose or gain a significant amount of weight between their first and second pregnancies have a greater risk of complications during their second child’s birth, according to new research. Research from the NIHR Southampton Biomedical Research Centre has found women who are not overweight and lose significant weight (more than 3 kg/m2) between their first and second pregnancies could have a greater risk of premature birth than those who maintained a stable weight. This link was evident only in women whose body mass index was within the recommended range of 18.5 and 24.9 kg/m2 at the start of their first pregnancy. Only 1 in a 100 of these women lost more than 3 kg/m2 between their pregnancies. The relationship is not necessary causal – for example, ill general health or stress could lead to both weight loss and premature birth. Nevertheless, these findings could help midwives and other health professionals identify women who may have greater odds of premature birth. Getting it just right The findings, published in the scientific journal PLOS One, did not show a link between weight loss and premature birth in women with overweight or obesity at the start of their first pregnancy, or in women who gained weight between pregnancies. Nevertheless another study, carried out by the same research team and published in BMJ Open, has demonstrated that a higher proportion of babies born to women who gained significant weight between pregnancies were too large at birth, compared to women who lost weight or remained at a stable weight between pregnancies. Women who gained a significant amount of weight by the start of their second pregnancy were more likely to be smokers, unemployed, with lower educational attainment and to have a longer interpregnancy interval, compared with those who maintained a stable weight between pregnancies. The study also found that overweight women who lost weight after a large-for-gestational-age birth (LGA) in their first pregnancy were less likely to have another large baby in their second pregnancy. LGA birth carries increased risk for an induced delivery or caesarean section and obesity for the child later in life. Key window of opportunity In these studies, the researchers found losing weight was much less common than gaining weight between pregnancies. They show that about half of all women gain weight between their first and second pregnancies compared to under 1 in 6 women losing weight during that period. They therefore recommend that the optimal situation is to be within the recommended weight range (18.5 and 24.9 kg/m2) at the start of each pregnancy. Dr Nisreen Alwan of the Faculty of Medicine at the University of Southampton, who led the research said, “The period between pregnancies is a key window of opportunity to improve health given the close contact families have with health and care professionals, but there has been little research into effective ways to support mothers maintain a healthy weight in this period.” “It is standard practice to weigh mothers at the start of pregnancy, and a comparison to their weight at the start of previous pregnancies could flag up any risks, giving mothers and health professionals the chance to take steps to improve pregnancy and later health outcomes.” Better pregnancy support Dr Alwan’s team, which included Grace Grove and Nida Ziauddeen, studied data from 2003 to 2018 of around 15,000 women who received antenatal care and lived in Southampton and surrounding parts of Hampshire during at least two of their pregnancies. As well as studying the mothers’ weight, they looked at other social and behavioural factors such as education, employment and smoking. The research was supported by research grants from the Academy of Medical Sciences and Wellcome Trust, and the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, and involved researchers affiliated with both the University Hospital Southampton Foundation Trust and the University of Southampton. It is now hoped that these findings and future research into this subject will encourage healthcare professionals and commissioners to provide better support to women between pregnancies, helping them to reach and maintain their optimal weight, leading to better health outcomes for both mothers and children.

A new vaccine could protect patients with chronic obstructive pulmonary disease (COPD) against lung infections that worsen their condition, with the potential to save lives. Southampton researchers, in collaboration with GlaxoSmithKline, are now leading the testing of a new vaccine that targets the bacteria non-typeable Haemophilus influenzae (NTHi), a common cause of severe and potentially fatal lung infections in COPD patients. This work builds on five years of collaborative studies at the NIHR BRC which identified NTHi as the key driver to deteriorations in COPD called exacerbations. In a recent clinical trial led by University of Southampton researcher Professor Tom Wilkinson at University Hospital Southampton NHS Foundation Trust, the vaccine successfully triggered an immune response against the bacteria, with this protective effect still detectable a year later. The results, published in the medical journal Vaccine, also showed participants who were vaccinated tended to have fewer events when their condition worsened compared to those who were not. Preventing flare-ups COPD is a chronic lung condition that causes long-term breathing difficulties, coughing and wheezing. It affects around three million people in the UK. Lung infections can cause worsening of symptoms, known as exacerbations or flare-ups, and are often caused by NTHi bacteria. The trial recruited adults between 40 and 80 years old with moderate or severe COPD with a history of flare-ups, and assessed how safe the vaccine was and how effective it was at preventing flare-ups. Professor Wilkinson, said, “These are really exciting results, as it shows we are moving in the right direction. “COPD is a debilitating condition that causes more than three million deaths around the world every year. Exacerbations of COPD can come on very quickly and can be very harmful. “These latest results now pave the way for further work to assess whether the vaccine against NTHi could prevent COPD exacerbations and have a positive impact on COPD symptoms and long-term outcomes for patients."

Southampton researchers are set to be part of a €80 million (£70 million) initiative aiming to better target treatments for the millions worldwide living with autoimmune, inflammatory or allergic diseases. Autoimmune, inflammatory and allergic diseases impact the wellbeing of millions of people around the globe, placing major cost and resource strains on healthcare systems. Although many different treatments are available, each person’s response varies greatly and is unpredictable, with too little known about these conditions at the molecular level. Now 3TR, a world-first public-private initiative, aims to identify new ‘biomarkers’ (molecules associated with a disease or response to treatment) and molecular pathways, to predict and measure peoples’ responses to different treatments for seven different diseases. Seeing the big picture 3TR brings together experts from across medical disciplines, profiling technology, systems biology and bioinformatics, plus specialists from innovative bioscience firms and leading pharmaceutical companies. Together they will work to better understand the molecular basis of systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease (including ulcerative colitis and Crohn’s disease), asthma, and chronic obstructive pulmonary disease. Recent studies have shown that certain patterns at the molecular level are shared by people living with these different diseases, suggesting they may also share common responses to treatments and patterns of disease progression. “By working with large numbers of new patients across Europe, combining their medical records, molecular and microbiological profiles with data from patients already part of research data, 3TR will give us a picture big enough and detailed enough to unpick what predicts disease progression and treatment response,” explains Professor Ratko Djukanovic, respiratory consultant and Southampton co-lead for the study. Predicting if drugs will work All data will be gathered on a central system, allowing detailed and comprehensive analysis for new molecular patterns and pathways using state-of-the-art bioinformatics and biostatistics methods. Through close working with clinical services and patient groups, 3TR aims to rapidly translate this knowledge and project outcomes into clinical benefit. “Treatment is currently very much on a trial-and-error basis, informed by a doctor’s experience, that presents challenges for their wellbeing and for managing progression of their symptoms. 3TR offers the prospect of evidence-based tests that accurately predict whether a drug will work for someone or not,” comments Professor Graham Roberts, consultant in paediatric allergy and Southampton co-lead for the study.

Researchers in the UK and Europe have discovered the bacteria which causes whooping cough can “lurk silently” in the noses and throats of healthy people. It is the first time scientists have confirmed a person can live with the bacteria – Bordetella pertussis – without becoming unwell, meaning they could unknowingly transmit the infection to other individuals. The discovery, made by a team based at University Hospital Southampton, explains why clinicians across the world are seeing an increase in sporadic outbreaks of the condition. What is whooping cough? Whooping cough, also known as pertussis, is a highly-contagious bacterial infection which is spread through the coughs and sneezes of an infected person. It causes repeated coughing that can last for two to three months or more and affects around 16 million people every year worldwide, particularly in developing countries, causing around 200,000 preventable deaths in children. There were 25,891 cases diagnosed in the UK between 2012 and 2018 compared to 6,216 between 2005 and 2011 – a four-fold increase. Adults suffer a milder form of the disease compared to young children but can still have an unpleasant cough for up to three months, while babies under the age of six months can be vulnerable to severe and life-threatening complications. Spread unknowingly Although a vaccine is offered to all babies in the UK – where 18 have died as a result of the infection since 2012 – it does not offer lifelong protection and is now less effective than it was 15 years ago. This is why the Southampton discovery is so significant – it means the bacteria can spread from person to person, silently, and cause disease in those who are not immune, including babies, and those not vaccinated. The researchers at UHS, led by Professor Robert Read, inoculated 34 human volunteers with Bordetella pertussis via nose drops and monitored them in a research facility for 17 days. They assessed their immune responses before giving them an antibiotic to clear the infection. The results, published in the journal Clinical Infectious Diseases, showed participants could be safely infected without developing symptoms and cleared of the bacteria within two days. “The study showed that the bacterium which causes whooping cough can lurk silently in the nose and throat of even healthy members of the community,” explained Prof Read, who is director of the NIHR Southampton Biomedical Research Centre. “This is extremely important as it explains why we are seeing episodic outbreaks of whooping cough throughout the world, with serious disease occurring in those people who are not vaccinated or who had their vaccines a long time ago.” The £2.3 million study forms part of a wider £24 million European project, PERISCOPE, funded by the Bill & Melinda Gates Foundation and the Innovative Medicines Initiative (IMI), involving experts from 22 institutions across 11 countries. Prof Read added: "In future work, the team will be able to learn more about what protects people from infection and will be able to test new vaccines and strategies to prevent whooping cough."

Doctors in Southampton have found an eight-week nutrient supplement for breastfeeding mums can help prevent weight loss and boost the growth of premature babies after they leave hospital. Almost half (45%) of babies born prematurely – before 37 weeks – suffer from growth failure due to additional dietary requirements which cannot be met through breastfeeding alone. Currently it is standard practice across the UK is to provide exclusively breastfed preterm babies with a protein and mineral-packed supplement, known as breast milk fortifier, during their time on neonatal units to complement mothers’ breast milk while it is delivered via a nasogastric tube. However, this is usually stopped prior to discharge from hospital when babies transition to oral breast milk feeds and, as breast milk fortifier supplements are not prescribed by GPs, the additional nutrients they need are largely obtained from bottle-fed formula. This, though, can affect the confidence of mothers to breastfeed and result in them choosing not to continue. Preventing a dip in weight “Preterm infants are so vulnerable and breastfeeding is encouraged to best support premature babies’ needs but breast milk alone doesn’t always meet their increased dietary requirements,” said Dr Luise Marino (below), clinical academic paediatric dietitian at Southampton Children’s Hospital. Breastmilk fortifier contains extra protein and minerals such as phosphorus and calcium to promote bone growth, but it is currently stopped before premature babies are discharged home. As it is not available from GPs, this can lead to a reduction in growth at a crucial time in their development. Dr Marino, consultant neonatologists Dr Mark Johnson and Dr Freya Pearson and dietitian Carol Fudge looked at the effects of supplying the supplement to 32 mums upon discharge for use at home for eight weeks. They recommended that four sachets of milk fortifier were added to 40 millilitres of expressed breast milk, with five millilitres administered orally before each breastfeed or eight times per day. This provided an additional 191 kcal, six grams protein, 111 milligrams phosphorus and 192 milligrams calcium per day. The quality improvement study, published online by the journal Archives of Disease in Childhood, found use of the fortifier after leaving hospital prevented a dip in babies’ weight and resulted in better growth at eight weeks and a year. Protecting breastfeeding Parents who took part in a questionnaire about the study were positive about the use of breast milk fortifier at home, finding it easy to do. They also reported feeling less worried about the growth of their babies, with mothers saying it helped boost confidence in their ability to breastfeed. Dr Marino added: "In this small group of infants, this method appeared to improve growth while also supporting, promoting and protecting breastfeeding in this vulnerable population group." Due to the success of the study at University Hospital Southampton NHS Foundation Trust, the researchers are now looking to run a larger scale study at sites across the UK.