The adaptation that all infants are required to make upon entering life outside of the womb is complex. Many physiological changes have to take place for the newborn to survive outside their mother’s womb once he or she has taken their first few breaths. Approximately 10% of all infants will require some help to make this adaptation. The CAPNO Trial is evaluating the role of quantitative versus qualitative carbon dioxide monitoring in very preterm infants in these first few minutes of life, with a view to improving neonatal transition and preventing hypocapnia/hypercapnia.
When an infant requires resuscitation, heart rate is a factor that helps in determining what treatments (or interventions) may be needed. Although the use of non-invasive electrocardiography (ECG) monitoring is a standard of care in the neonatal intensive care unit (NICU), its use is less well studied in the delivery room. Therefore, we hope to perform ECG monitoring in the delivery room on all infants included in this study.
The CUPID study – Clamping the Umbilical cord in Premature Deliveries is a Randomised Controlled Pilot Trial.
This is a pilot study which assesses three umbilical cord clamping strategies in preterm infants of less than 32 weeks gestation. The aim of the study is to compare maternal and neonatal outcomes following either immediate cord clamping, delayed cord clamping with ventilation initiated at the bedside and umbilical cord milking. Recruitment is ongoing in the delivery rooms of CUMH.
Seizures or fits in newborn babies are classed as a medical emergency and require urgent treatment. However, they are impossible to detect without continuous brain monitoring using EEG. Specialist expertise is required for EEG interpretation and, all too often, no such expert is on-hand in neonatal intensive care units, which can result in important brain events being missed. Continuous monitoring of major vital signs is critical to aiding the clinical management of frequent complications associated with sick infants.
Over the last ten years, researchers and clinicians at the INFANT Centre have developed highly sophisticated algorithms to automatically analyse the neonatal EEGs. These algorithms can help to ensure that patients receive the care they need, even when expert neonatologists are not immediately available. The INFANT Centre has partnered with IBM to develop a solution based on IBM’s InfoSphere Streams computing platform, which allows the transmission of raw EEG data from the cot-side to the cloud.
The platform takes the stream of data from sensors monitoring the baby, interprets that data using the algorithms created by INFANT engineers, and then sends alerts back to a Neonatal monitor. This surveillance service can be provided to multiple hospital rooms, or even multiple hospitals, in one location. As a result, the data move, rather than the baby – this is crucial in saving time and minimising disturbance when dealing with infants in intensive care. To protect patient confidentiality, individual patient data is de-coupled from the monitoring alert data. Results can be securely viewed from any user authorised web-enabled terminal, PC, tablet or smartphone
The BabySafe project aims to develop an EEG/ECG electrode for monitoring the neurological wellbeing of the fetus during labour, and to develop a supporting algorithm to interpret the fetal EEG for non-expert users.
The product being developed for BABYSAFE is a multi-modality (EEG, ECG) sensor array (Fetal Scalp Electrode : FSE) which can be attached to the scalp of an infant during delivery. The sensory array is then connected to a recording system to record fetal heart rate, maternal heart rate and fetal EEG activity.
A small cohort of expectant mothers have been recruited to the study. The pilot has focussed on capturing ECG from pregnant women using electrodes placed on the abdomen. Initially, ultrasound was used to locate the fetal heart, and direct electrode placement on the abdomen. Currently, a ‘kite electrode placement’ is used to capture the Fetal ECG and ultra sound used to monitor movement of the fetus. This preliminary study is providing the necessary data to allow INFANT engineers to separate and distinguish mothers’ heartbeat from the fetal heartbeat.
BASELINE is the first Irish birth cohort study. There are a number of birth cohort studies worldwide, but few, if any of them have such detailed information about babies. The BASELINE study utilises data which extends back to the very first weeks of pregnancy.
BASELINE is a collaborative study between the Departments of Paediatrics and Child Health, Obstetrics and Gynaecology and Food and Nutritional Science, University College Cork, and the Department of Dermatology, Trinity College, Dublin. Recruitment of mothers took place in Cork University Maternity Hospital and follow up of the BASELINE children will take place in the HRB-CRF- Cork Children’s Discovery Centre in Cork University Hospital.
Children were seen at 2, 6, 12 and 24 months and the 5 year follow up is currently taking place. Initially, the study focused on three main research questions: the effects of poor growth in the womb, the incidence and prevalence of food allergy and eczema in early childhood and the incidence and effects of maternal and infant vitamin D status on the growth and health of Irish children.
BASELINE is also storing maternal blood samples taken during pregnancy and samples from the babies’ umbilical cords at birth. This will allow us to look back later to see if any elements in the umbilical cord, or mother’s blood could have been used to predict disease in these children.
One in every 50 babies born will need some form of resuscitation at birth and approximately 20% of those will suffer a significant lack of oxygen or blood supply to the brain and may develop severe conditions such as hypoxic-ischaemic encephalopathy (HIE). HIE remains an important cause of negative long term prognosis, with a high risk of learning disability, cerebral palsy, epilepsy, visual or hearing loss. There is an effective therapy, in the form of therapeutic hypothermia (cooling the baby), but to be effective it must be commenced within the first few hours after birth.
The clinical need is for a fast and reliable way to identify which babies will need such treatment. The BiHIvE project is analysing at-birth blood biomarkers that will uniquely identify the at-risk babies and send them for early specialist intervention. We will then develop a point-of-care diagnostic test based on measurement of the relevant biomarkers in the delivery room. This world-first will help doctors to prevent brain injury and improve the baby’s chances of a normal survival, free from disability. BiHiVe is closed to recruitment but currently following up all of the Infants enrolled.
The main goal of the COMBINE -The COrk Nutrition and MicroBiome Maternal-InfaNt Cohort Study is to improve our understanding of diet and gut microbiome composition for healthy growth and neurological development in early childhood.
COMBINE represents a unique collaboration between INFANT and APC and our industry partner Mead Johnson Nutrition. COMBINE is a prospective longitudinal mother-infant birth cohort study with a parallel dietary intervention study of an investigative formula. Recruitment for IMPROvED, an EU funded pregnancy cohort among primiparous women, is on-going at CUMH and COMBINE is recruiting infants born to these mothers.
– Conducting a detailed, quantitative prospective analysis of infant feeding over the first 24 months, including brand-level data on formula and supplemental products. These data will enable us to determine the effects of diet on early growth and development, body composition, and nutritional status over the first two years of life, with validated early obesity and neurological health outcomes.
– Defining the influence of mode of delivery, early life events (e.g. infection and antibiotic use) and early feeding practices on the composition of the gut microbiota of infants.
– Establishing how the gut microbiome can enhance nutritional status in infants with downstream benefits on body composition and neurological development.
– Establishing a state-of-the-art biobanks for maternal and infant samples, including blood, DNA, RNA, stool, saliva and human milk. This is supported by a bespoke online, quality assured, secure and detailed phenotype meta-database to develop biomarkers (and/or algorithms) for early detection. These measures provide a foundation for investigating future hypotheses in the cohort as it grows.
Facebook Combine Cohort Study
The NeoView project aims to improve patient outcome, reduce parental stress, and increase procedural success rates in the neonatal intensive care environment. This will be achieved by introducing innovative technology to intensive care which enables enhanced monitoring and enhanced staff and parental education.
NEOVIEW will provide families with virtual visitation to their child, enabling clinicians to improve the level of care when they are not on the unit and enhancing patient outcomes through improved care regimes and education for training staff. As a result, the journey of infants and their parents through the NICU will be improved, aligning with the centre’s objective to deliver beneficial interventions that will fundamentally change perinatal care.
In addition, there will be parental educational content that can be accessed at the point of care and remotely. The impact of the technology on parental wellness and stress will be assessed. By enhancing the experience of parents and families in such difficult circumstances, parental-infant bonding can be improved, ultimately leading to shorter hospital stays. Similarly, by improving health outcomes for new born babies through a reduction in procedural related errors, and through positively addressing health issues such as familial stress, the NeoView project will have a number of impacts upon healthcare economics leading to savings for the health system.
This industry-partnered project will develop, test and improve a seizure detection algorithm for premature babies in the Neonatal Intensive Care Unit. We have access to a unique data set for this purpose, and the steps involved will include feature selection, data classification and data validation. The algorithm will be developed in a regulatory compliant way so that it is ready for licence within 3 years. The project aims are to:
-Develop a robust, reliable, automated seizure detection system for the detection of seizures in preterm neonates and facilitate prompt treatment
-Validate this algorithm on a large multi-centre dataset
-Prepare the algorithm in a regulatory compliant manner such that this algorithm is ready for licence at the end of the project.
Sustained periods of low Blood Pressure (BP) in preterm babies can lead to brain injury. At the same time, the excessive treatment of low blood pressure has been associated with increased risk of poor neurodevelopmental outcomes. In fact, many babies do not show any physical sign of distress and may not need any treatment. In this respect, the term ‘permissive hypotension’ is appropriate where the babies with only a clear sign of brain dysfunction are treated.
In the NICU, it is difficult to continuously monitor neurological function, typically done by means of EEG and brain oxygenation (NIRS). We know that these signals may be altered by significant periods of low BP. However, despite the importance of this information for clinical management, the clinical team caring for the preterm baby find it difficult or impossible to interpret these signals at the cot-side.
NEUROPROBE will develop an innovative method of continuously analysing changes in preterm EEG, NIRS and blood pressure data and present this information in real time as a brain health index. Periods of low BP that have significant impact on brain oxygenation and activity can thus be rapidly identified and appropriate therapies administered. NEUROPROBE will develop an automated multimodal EEG, BP and cerebral oxygenation monitoring system, to be used for constant surveillance in the preterm neonate, based on advanced signal processing and machine learning-based decision making.
PiNPoINT (Personalised Nutrition for the Preterm Infant) is a large-scale project aiming to implement a novel nutritional management strategy in preterm very low birth weight (VLBW) infants using real-time nutritional data collection and monitoring. PiNPoINT follows from the results of the BabyGrow longitudinal preterm nutrition study that quantified nutrition and growth in a small cohort of preterm infants. The project aims to address the lack of knowledge around nutritional requirement in VLBW infants to optimize growth and development of bone, body composition and brain tissue for improved functional outcomes and promotion of long-term health and quality of life. This is the largest project of its kind in Ireland.
The SafeBooSC-II trial is geared towards safeguarding the brains of our smallest children. It is a phase II feasibility randomised clinical trial on near-infrared spectroscopy monitoring combined with a treatment guideline in premature infant.
INFANT is a participant in the SafebooSC II trial, which was funded by the Danish Strategic Council to assess the role of cerebral oxygenation monitoring in extremely preterm infants in the first three days of life. The short term results of this study have recently been published, showing that cerebral oxygenation monitoring, with a treatment guideline, resulted in a reduction in the amount of cerebral hypoxia in the first three days of life. Long-term neurodevelopmental outcome is ongoing and the next stage of the project is to conduct a significantly larger study enrolling 1600 infants across Europe
The SmarTi – Stressed Microbial Transfer to the Infant project aims to determine the impact of Maternal Prenatal Stress (MPNS) and Maternal Irritable Bowel Syndrome (MIBS) on the intestinal microbiota during pregnancy. The project will also determine if this ‘stressed microbiota’ is transmitted to the infant at birth. We are assessing the consequence of these changes as the infant microbiome is seeded and developed.