INFANT’s preterm nutrition team last night received the Health and Social Care Professions Driving Quality and Improvement Award for their BabyGrow Project. The winners were announced at the Inaugural Best Practice and Innovation Awards hosted by the HSE’s Health & Social Care Professions Office in the Royal College of Surgeons, Dublin, on the 6th November.

The National HSCP awards recognise and celebrate examples of best practice and innovation.

Pictured L to R: Ms. Sarah Fenton, Senior Pharmacist; Dr. Ann-Marie Brennan, Clinical Specialist Neonatal Dietitian; Ms. Jennifer Wilkinson, Senior Neonatal Dietitian; Mrs. Annemarie Fanning, Dietitian Manager; Dr. Brendan Murphy, Consultant Neonatologist.

BabyGrow: Translating Research into Improved Nutritional Care for Preterm Infants was a multi-disciplinary preterm nutrition project, led by Prof Mairead Kiely (Nutrition Scientist, INFANT Nutrition platform lead), Dr Brendan Murphy (Consultant Neonatologist) and Dr AnnMarie Brennan (Neonatal Dietitian). The collaboration in preterm nutrition between Cork University Maternity Hospital (CUMH), University College Cork (UCC), industry and the HSE was initiated over a decade ago and continues to grow within the Nutrition platform at the INFANT centre.

The goals of the BabyGrow study was to quantify nutritional support and growth rate in preterm infants in the NICU and to develop and deliver data driven innovations for improvement of nutritional support.

Dr Brennan conducted her PhD on BabyGrow and her analysis of parenteral nutrition, the focus of the HSCP award, was a transformative piece of research, which led to the development and implementation of a new intravenous nutrition solution for safer and better nutritional support in the NICU.

In Ireland, ~1 in 100 babies (~600 babies per annum) are born preterm and very low birth weight (VLBW <1500g). One in four preterm infants has evidence of developmental delay by the time they reach school-age. Appropriate nutrition during early life is essential for healthy growth and neurological development. As these vulnerable infants transition from exclusively intravenous nutrition onto milk feeds over the first 7 to 10 days of life, nutrition provision is complex and challenging, with a high risk for adverse short and long term effects. In the absence of evidence-based practice guidelines, nourishing preterm infants during this critical period has traditionally been based on a ‘best guess’ approach.

The BabyGrow nutrition and growth study revealed substantial nutrient deficits and growth failure in VLBW infants during the first weeks of life. This had been observed previously in other units, but the BabyGrow database, which was uniquely designed to provide the most disaggregated and detailed portrait of nutrient delivery within the NICU, provided a first-time opportunity to conduct in silico data modelling experiments.  The outcome of this data-driven approach was the development of novel parenteral products with improved nutritional composition, making them suitable to deliver recommended levels of nutrients to support growth without providing excessive intakes. This is the first time nutrient modeling has been used to determine the composition of intravenous nutrition that fully meets the needs of VLBW infants, who have a complex nutritional journey. The team partnered with industry to translate this research into clinical practice and embarked on a 6 month product development phase.

In February 2018, following a dietitian-led implementation strategy, the two new intravenous nutrition products, supported by an evidence-based guideline, were introduced into CUMH. The post implementation audit shows full adoption with infants receiving safer and better nutrition. To date, this work has been published in four international peer-reviewed publications and the evaluation is ongoing.

As part of the PiNPoINT (Personalised Nutrition for the Preterm Infant) project, funded by a consortium led by Science Foundation Ireland, the same team is observing infants receiving the new intravenous nutrition products and conducting detailed growth, developmental and neurological assessments in these babies throughout their hospital stay and during infancy.

The National Clinical Programme for Paediatrics and Neonatology Parenteral Nutrition Expert Group have endorsed the new products and evidence-based guideline and national rollout is planned. Utilising the improved intravenous nutrition products instead of bespoke individualised prescriptions on a daily basis will deliver cost savings of ~€60,000 per annum to CUMH, a 20% saving on our overall intravenous nutrition costs supply, with potential for far greater cost savings nationally. Very positive feedback has been received from a staff evaluation, who have reported the new developments as “user friendly”, “easy to follow”, “prescribing is easier and safer” and, “babies in my care are receiving better and safer nutrition”.

This collaborative project, between HSE dietitians, neonatologists, pharmacists and nutrition scientists at UCC, has delivered innovative, evidence-based solutions to a long-standing unmet need for the benefit of the most vulnerable people in society.

As published in UCC, College of Medicine and Health “The Research Impact Anthology – Research for a Healthier Future”.

When babies are born it is usually a joyous occasion. In most cases it goes well, but some babies are born either too soon or very sick. They may not have grown well enough in the womb or may have suffered an injury during labour. When you consider that there are 65,000 babies born annually in Ireland – the highest birth rate in Europe – then it is not surprising that we need a research centre to explore how we can make pregnancy and birth safer for our mums and babies,and improve outcomes.

Our dedicated perinatal translational research centre reaches out from the bench to the cotside – often little incubators – in a very real way, so that our innovations are put into clinical practice. Our centre is the first of its kind in the country. INFANT, the Irish Centre for Fetal and Neonatal Translational Research, was established in September 2013 by Prof. Geraldine Boylan and Prof. Louise Kenny, two innovative academics in perinatal
research at our college. They secured a starting grant
from Science Foundation Ireland (SFI) to develop a dedicated research centre in UCC.

Geraldine’s speciality was in the neurophysiology of the baby brain and Louise’s expertise was in preeclampsia and obstetrics. They had each built their own individual talented research teams for several years, and in INFANT, they pooled their resources and built multi-disciplinary programmes. Geraldine, INFANT director, says: “We combined our efforts. We said mothers and babies should be together, so the research should be together!

“We had an excellent research team and a bedrock of good work going on; we were all in the right place at the right time. And what we have in Cork, also, is a great synergy between the university and the hospitals (Cork University Maternity Hospital and Cork University Hospital); it has been perfect for working well in the perinatal space.”

“We received €5.9M from SFI to set up the centre in 2013, which enabled us to build the core infrastructure of the centre, and now we have a funding portfolio of €30M. We have outperformed all of our key performance targets and now have 100 staff working in INFANT. We have won funding from the EU, the Wellcome Trust and from industry and received donations through philanthropy. For every one euro of funding we have received from the state, we have been awarded another five euros on top of that, from non-Exchequer sources,” she says proudly.

“Working closely with industry enables our team to get their technologies or new devices or drugs realised, as speedily as possible. This is so important for these vulnerable populations.” Research at INFANT, of course, touches all humanity. Our dedicated researchers are on call 24/7 since a lot of their work explores problematic situations that happen at birth and afterwards, and how these can be prevented down the road for other mums and babies.

None of this could be done, of course, without the families who engage in our research with our multidisciplinary team of doctors, nurses, scientists, engineers, postgraduate students and research support staff. “We need to study mothers and we need to study the babies to find out why problems happen, and we can only do that because of the parents and families who engage with our research. They really understand why we are doing it,” says Geraldine. “I am constantly overwhelmed by their altruism and their generosity. It doesn’t matter what funding in the world we get – without them, this research wouldn’t happen.”

“For a long time children did not participate in research, and as a result, most of the medical devices and many of the drugs we use have never been properly tested for infants or children – even though their development and physiology are completely different to adults. The evidence base isn’t there, so we are working to make sure that medical devices and treatments for children are tested and developed to the best possible standards.”

INFANT is changing that landscape nationally and internationally. Our research is known all over the world; we have delivered over 300 highly cited academic publications in the last four years alone. We are known throughout the world in relation to pre-eclampsia, newborn brain injury, maternal and infant nutrition, and infant allergy. We have lots of high impact papers published in those areas and more in the pipeline.

For the director, she is fully confident that there is no stopping their phenomenal pace of growth: “We have only just scratched the surface of what we need to do for mothers and babies,” she says. “There’s so much more yet to be done and we won’t stop!”

Emma Snapes, INFANT’s Biobanking Manager received the National Standards Authority of Ireland award at the NSAI Annual Standards Forum in Dublin. The award was in recognition of Emma’s exceptional dedication to standards development.

Emma is the Irish academic representative and International Expert to ISO TC276 for Biotechnology and was instrumental in the development of ISO 20387 (2018): EN, the first dedicated biobanking standard.

Emma is continuing her work with ISO TC276 and is currently working on a technical report that will accompany the biobanking standard to help interpret the requirements for each unique set up.

“I would likely to sincerely thank all the many individuals too numerous to mention in helping promote the Irish biobanking voice and in particular its expression in the horizontal biobanking standard. Encouragingly, this voice was one I often heard echoed back from other countries experts. It is my hope that those who undertake to fulfil the requirements laid out in the standard will realise the value in resultant high quality, reproducible results and timely achievement of research goals. Special thanks to my biobanking colleague and dear friend, Dr Aisling Doyle, who accompanied me to the award ceremony in Dublin. Aisling and I work closely together and together provide constant round the clock support for INFANT’s biobanking concerns. I remain ever grateful to INFANT directorship and UCC management for enabling her to partake in standards creation”.

Well done Emma!

INFANT research matters

A huge thanks to everyone who contacted us or campaigned to raise awareness about INFANT over the last few weeks. Your generosity and support is extraordinary and we are immensely grateful. We want you to know that the INFANT team is determined to continue delivering high impact and vitally important research for the benefit of women and children in Ireland and worldwide.

Geraldine Boylan

Director, INFANT Research Centre

New Research by INFANT PhD candidate, Gwinyai Masukume has been published in Scientific Reports.

The work is exploring the association between Caesarean Section (CS) and childhood obesity. Childhood obesity has been linked to CS via lack of exposure to vaginal microflora although the literature is inconsistent. The team investigated the association between CS birth and the risk of childhood obesity using the nationally representative Growing-Up-in-Ireland (GUI) cohort.

The study recruited 11134 infants. The exposure was categorised into normal vaginal birth (VD) [reference], assisted VD, elective (planned) CS and emergency (unplanned) CS.

After further analysis of the infants weight and height the team found insufficient evidence to support a causal relationship between elective CS and childhood obesity.

FULL PAPER HERE: https://www.nature.com/articles/s41598-018-33482-z

Our research partners, Incereb Ltd, manufacturer of the neon neonatal EEG electrode array, have been aquired by Lifelines Neurodiagnostic Systems, Inc., provider of neurodiagnostic equipment and services.

Simon Griffin, CEO of Lifelines, noted, “We have been working with Incereb for several years in the US market, and their neon product is a perfect fit with our technology and growth plans. We are very excited not only to work with Jim Roche and Incereb on new product development but also with the INFANT Centre at University College Cork and the fantastic research being performed there under the stewardship of Professor Geraldine Boylan.”

Jim Roche, CEO of Incereb, noted “We have worked with Professor Geraldine Boylan since the formation of Incereb, and as an industry partner in INFANT. With LIfelines as our partners, and with their technology fitting seamlessly with Incerebs technology, we are now able to offer a complete EEG monitoring solution for the ICU”.

Incereb will remain operating in Dublin as a subsidiary of the Lifelines group of companies. Plans are to increase R&D spending on a new product pipeline and grow the business by developing new markets and product lines.

“This is a perfect fit for Incereb in terms of our product offering and Lifelines’ sales and distribution network,” says Incereb CEO, Jim Roche, of the acquisition. Incereb has been working with Lifelines since 2015 to distribute Incereb in the US, and more recently worldwide.

“Declan O’Mahoney, Incereb director, has worked tirelessly with the management team consisting of Simon Forsyth, Paul Phillips, and me to get Incereb to this next stage of its evolution,” says Roche. “We are delighted with this acquisition and look forward to growing our business and product range together to bring neonatal and intensive care neuroprotective monitoring to the next level.”

Our PhD researcher, Rachel Williamson, won a Young Investigator Award from the Preeclampsia Foundation at the ISSHP European Conference in Amsterdam.

Eleni Tsiagas of the Preeclampsia Foundation and Rachel Williamson, winner of the Young Investigator Award, ISSHP 2018

Rachel’s presentation at the conference is entitled Investigating the Therapeutic Effects of L-Ergothionine As A Treatment for Pre-eclampsia 

Abstract:

Pre-eclampsia is proposed to result from placental ischemia, explosing the placenta to elevated levels of oxidative stress. L-Ergothionine is a natural water-soluble compound derived from histidine and is a physiological antioxidant due to its preferential concentration in high oxidative stress organs. L- Ergothionine has been shown to possess antioxidant, cytoprotective and anti-inflammatory effects, establishing its potential as a treatment for preeclampsia.

Objectives: To investigate the therapeutic effects of L- Ergothionine as a treatment for preeclampsia using the in-vivo reduced uterine perfusion pressure (RUPP) rat model.

Methods: L- Ergothionine (25mg/kg/day) was administered on gestational day 11 (GD11). RUPP was induced by placing silver clips on the abdominal aorta and the ovarian arteries on GD14. Mean arterial blood pressure (MABP) and vascular function were measured in all four groups. Pup and placental weights were also measured. Data is presented using the mean ± SD.

Results: L- Ergothionine reduced MABP in the group compaed to RUPP controls (134 mmHg  143 mmHg). There was a significant reduction in pup weight in RUPP control group compared to sham controls (1.802± 0.07 v 2.245 ± 0.06, P>0.0001). L- Ergothionine resuced fetal growth restriction in the RUPP group compared with the RUPP control group (2.048 ± 0.09 v 1.802 ± 0.07, P=0.05). Mesenteric arteries from the RUPP control group displayed impaired vasorelaxation, however pre-treatment with L- Ergothionine ameliorated this endothelial dysfunction.

Conclusion: Pre-treatment with L- Ergothionine in the RUPP model mediated some of the pathophysiological characteristics of pre-eclampsia, therefore, highlighting its potential as a treatment for pre-eclampsia.

As published in the Irish Examiner: 

Prof Geraldine Boylan, INFANT co-founder and director, and Professor of Neurophysiology at UCC, says it is vital to continue research into maternal and child health.

INFANT is Ireland’s only dedicated research centre spanning maternal and child health and has been recognised internationally as a world-leading organisation that is responsible for a number of research breakthroughs and life-saving science for mothers and babies.

We have made ground-breaking discoveries in neonatal seizure detection, pre-eclampsia, neonatal brain injury, maternal nutrition, and childhood allergy. INFANT has been at the heart of perinatal research and innovation for more than five years.

Funding from Science Foundation Ireland in 2013 was catalytic to the success of the INFANT Centre, and once  it was established, it was quickly recognised as a global force for development in perinatal healthcare and research.

Competitive research grants, collaboration requests and philanthropic funding from national and international sources supplemented the initial €6 million in start-up funding to grow to its €30 million portfolio today.

Prof Geraldine Boylan, INFANT Director 

Over the last five years, the INFANT Centre has been a high performing SFI research centre and it will continue working in this important area. INFANT is maturing and has a new ambitious programme that will build on the investment and success to date. This will require even more diversity of funding than before but the centre is confident of realising the initial vision of building an Institute of Maternal and Child Health of scale, impact and international.

For example, a number of new large-scale research programmes have been announced this Summer. INFANT is a lead partner in the Connect4Children network in Ireland, a European consortium developing paediatric clinical trials around the world which has one of the largest funding budgets (€140 million) awarded through the EU Innovative Medicines Initiative 2.

There is excellent paediatric research ongoing all over Ireland and the paediatric clinical trial infrastructure being built across Ireland will enable INFANT and its partners to access future funding to develop and test medicines specifically for children and infants.

Up to now, children and infants generally receive ‘smaller doses’ or a dilution of adult medicine rather than specifically designed treatments. One of INFANT’s key goals is to support the use of innovative trial designs and new quantitative methods to foster the development of paediatric medicines and to support research in rare paediatric diseases and high medical need areas.

INFANT is the only national research centre of scale working across the continuum of pregnant women, babies and young children.

INFANT as a clinical and translational centre must combine basic and applied research on real unmet clinical needs with a drive to bring innovations and solutions to these clinical problems to the market.

We do this by working with a wide range of stakeholders and funders — clinicians, scientists, engineers, industry, government, funding agencies, donors and patients.

We will continue to collaborate with these partners — local, national and international.

UCC is committed to ensuring that INFANT continues to grow, flourish and deliver on the tremendous impact it can bring to science and society. Ireland and Cork in particular has a unique competitive advantage for research and innovation in perinatal health.

The INFANT Centre continues to be committed to scientific excellence and impactful research. We will continue to work directly with many funders, collaborators and philanthropists and their foundations on this lifesaving and life-changing work in the area of neonatal and maternal care. We look forward to the continued collaboration with families who are the cornerstone of this effort.

As director, I am very proud to lead this important research centre. We are indebted to the wonderful families who take part in our research and I am very proud of the community of researchers and staff in INFANT who are so committed to making things better for mothers and babies around the world.

Following an SFI Research Centre programme call for funding, the new proposal of the INFANT Centre at UCC has not been funded at this time but instead has been recommended to proceed to a national open call in 2020. The Centre opened in 2013 with initial funding from Science Foundation Ireland, which will end in May 2019. INFANT will continue its research work funded by a diverse range of national and international funding agencies, industry partners and philanthropic donors.

INFANT’s mission is to improve health outcomes for mothers and babies by focusing on clinical and health research and innovation in pregnancy, birth and early childhood. The Centre has grown rapidly from its initial award of €6M to over €30M in five years comprising donations, competitive funding awards, and global partnerships with industry and academic researchers which  has enabled the development of INFANT to the point where it now has over 100 staff, a dedicated paediatric clinical research unit, an internationally recognised biobank, a world-leading data hub and other clinical research infrastructure in obstetrics and neonatology.

The support from SFI for the Centre has, to date, been a significant catalyst for major growth and development. It has allowed INFANT to develop breakthroughs in seizure detection and in areas such as pre-eclampsia diagnosis, maternal and new-born nutrition and allergy. The Centre will continue to develop these areas and support maternal and child health research and innovation in its next phase for the benefit of mums, babies and children in Ireland and worldwide.

Rhodri Cusack is the Thomas Mitchell Professor of Cognitive Neuroscience in Trinity College Dublin, and a world-renowned expert in his field. Prof Geraldine Boylan, Director of the INFANT Centre noted that “The appointment of Prof Cusack as an INFANT PI is very exciting, it expands the impact INFANT will have, and will enable us to gain even more momentum as a world-leading research centre, improving health outcomes for babies around the world”.

The Vice President for Research and Innovation at UCC, Professor Anita Maguire welcomed the addition of this talented research leader to the INFANT Research Centre, noting that “Prof Cusack brings research expertise which is entirely complementary to the current expertise within INFANT, and as a result his addition will open exiting new research opportunities with potential to contribute to improved health outcomes”.

Prof Cusack is the Thomas Mitchell Professor of Cognitive Neuroscience and head of the Cusack Lab in the Trinity College Institute of Neuroscience. As a graduate of Cambridge and the University of Birmingham, he has worked in the MRC Cognition and Brain Sciences Unit in Cambridge and more recently was Associate Professor at the Brain and Mind Institute of the University of Western Ontario. His research has been funded by the IRC, MRC, Wellcome Trust, BBSRC, EPSRC, CIHR, and NSERC. Rhodri has recently received a prestigious ERC Advanced Grant to explore neuroimaging and early infant brain development and has already started active research collaborations with INFANT in this area.

He and his team study the brain development of infants in their first year, a period in which many cognitive functions develop remarkably quickly. They also study how perinatal brain injury affects development and how some infants manage to be so resilient. Their research uses neuroimaging to predict the functional consequences of brain injury at an earlier age, as current behavioural and neurological tools are poor predictors of later impairments, which place stress on families and preclude earlier and more effective interventions. Prof Cusack’s team use a diverse set of neuroimaging methods. With magnetic resonance imaging (MRI) they study brain networks (using diffusion-weighted imaging, functional connectivity) and the developing responses to what an infant sees and hears (using functional MRI). They study infant behaviour and have pioneered ways to do large-scale testing online, and have developed many new tools that bring together computational models of cognition with new neuroimaging techniques, to answer the many fascinating and important questions concerning the origin of our minds. Prof. Cusack’s work and that of INFANT are well aligned strategically and this announcement highlights a formalising of current interactions.

We look forward to working with Rhodri, and warmly welcome him to the team.