Southampton Academy of Research

Dr Luise Marino is a Clinical Academic Paediatric Dietitian at University Hospital Southampton (UHS), and holder of a Research Leaders Programme (RLP) fellowship.

Her research interests focus on supporting the growth and development of babies and children with complex or chronic diseases. She is also the R&D lead for Division C at UHS.

Investigating babies’ metabolic signatures

When Luise first came to UHS, she noticed children with congenital heart disease (CHD) seemed smaller than other babies.

“I’ve always had an interest in nutrition support of children with CHD,” says Luise, “as it seemed those who were underweight at the time of surgery seemed to spend longer in hospital.”

She did an audit and found 28% of babies with CHD under the age of one were much shorter than expected for their age. Those who were underweight at the time of surgery spent more time in hospital.

The implementation of a regional nutrition pathway was found to significantly improve growth in infants before surgery. Yet despite the use of nutrient-rich formula milk, some babies still don’t grow well as expected. This could be because they didn’t have the right nutrition to support their growth.

To help to explain why, Luise is using her RLP fellowship to work with Prof Mark Beattie, Dr Mark Johnson and Prof Jonathan Swann. The work will build on Prof Swann’s research describing differences in urinary metabolites and the relationship with growth.

The group intend to collect urine samples once a month for six months from babies with CHD, preterm babies and those born small for their age. They will compare these samples against those from healthy infants to see if babies with poor growth have similar differences in urinary metabolites as those found in Prof Swann’s research. They plan to use the results to help improve the growth of these babies.

“Urine is the end product of metabolism,” Luise explains. “So if some babies have less of something (metabolites) compared to a healthy baby, then it might mean that we could potentially add something into their diet to better support growth.”

Supporting conversations about care

Luise also plans to use her fellowship to continue work on Chloe’s Card. Chloe’s card is a tool co-created with a former patient’s mum, communications agency Raised by Wolves (who provided pro-bono design expertise) and Prof Anne-Sophie Darlington.

Chloe’s Card seeks to help parents, with children of complex medical needs, feel heard and listened too during a hospital admission. During her fellowship she intends to work with Prof Darlington to develop an implementation plan for Chloe’s Card, so it can be used more widely.

“Chloe’s Card came about from a parent’s experience of care – where Chloe’s mum sadly felt unheard especially about feeding,” says Luise. “It can sometimes be hard for some parents to feel heard or get their point across. We hope Chloe’s Card will act as a prompt for parents to tell us what they feel we should know about their child and ask us what they don’t know about their care.”

Helping preterm babies grow better

Luise is also working with Dr Mark Johnson as part of her RLP fellowship. They are looking at using breast milk fortification to better support the growth of breastfed preterm infants following hospital discharge.

Breast milk is the best milk for babies. As preterm infants have increased nutrition needs, breast milk alone does not always support adequate growth. In hospital, babies have a multi-component fortifier added to breast milk helping infants grow. As breast milk fortifier is not available for prescription in the community, the fortifier is stopped before they go home. This often leads to poor weight gain and a switch to infant formula.

However, a quality improvement project sent babies home with enough breast milk fortifier until around six weeks of age. The team found the babies grew better after they left hospital and parents felt supported to continue breastfeeding. This is now standard practice at UHS.

During her RLP fellowship, Luise wants to build on this research to see if it helps mums to continue breastfeeding for longer. She’s working with Dr Johnson and the Southampton Clinical Trials Unit to design a feasibility study across three UK centres.

Recognition for non-medical research

Her RLP fellowship allows Luise to devote two days each week to research for up to three years. As well as developing and widening her portfolio of commercial research with companies, this will give her the time she needs to expand her research into all these different areas of child nutrition.

However, she not only intends to use this time to become a research leader, but also to support other non-medical healthcare professionals who are interested in research.

“My reason for applying for the RLP is that it’s a significant opportunity to be able to work towards becoming an independent researcher,” she says, “but also it’s an opportunity to mentor other people who may be newer to research.”

She praises UHS for establishing the RLP, and for opening it up to all health researchers. She says it recognises that non-medical research is an important contributor, and that people like her can be role models for others.

“The Trust Board obviously supported the investment in this, and it has the ability to really raise the profile of UHS research across a wide variety of different types of researchers, including both non-medics and medics. I think that it’s wonderful to be embraced within that fold.”