Researchers and Clinicians from University College Cork (UCC) have contributed to the Lancet Stillbirth Series: Ending Preventable Stillbirths, launched globally on 19 January 2016 and published in the prestigious medical journal.  This series builds on the original Lancet Stillbirths Series published in 2011, reviews where international progress has and has not been made, and shows what steps should be done to end preventable stillbirths by 2030.

Keelin O’Donoghue, Consultant Obstetrician, and Daniel Nuzum, Healthcare Chaplain, both from the Pregnancy Loss Research Group at UCC, are among the co-authors of one of the five seminal papers in the Series.  Formed in 2012, the Pregnancy Loss Research Group led by Dr O’Donoghue is based at the Department of Obstetrics and Gynaecology UCC and Cork University Maternity Hospital. Other group members Margaret Murphy and Sarah Meaney formed part of the Lancet Stillbirths High Income Countries Investigator Group that contributed to another of the Series papers.

The group are among 216 authors and advisors from more than 40 countries who have contributed to this Lancet Stillbirth Series, and present the clearest picture to date of the ongoing progress in reducing stillbirths, as well as missed opportunities, with a call to action for ending preventable stillbirths.

Every year globally, more than 2.6 million babies are stillborn. Dr Keelin O’Donoghue, Senior Lecturer UCC and Consultant Obstetrician CUMH states that “Of these 2.6 million stillbirths, 98% occur in low- and middle-income countries and almost half of all stillbirths happen during labour and birth. Most deaths result from problems that can be avoided with good maternity care such as the prevention or treatment of infections and pregnancy-related complications (e.g. high blood pressure, diabetes, or poor growth of the baby before birth.) Efforts to prevent stillbirth need to form part of normal healthcare of women and babies”. The series highlights that most stillbirths could be prevented during pregnancy, labour and birth, and that improvements in global maternity care will also prevent the deaths of mothers and newborn babies and ultimately improve child development.

In the face of the global burden of stillbirth, the impact of stillbirth can sometimes be overlooked in high-income countries such as Ireland. Daniel Nuzum, Healthcare Chaplain CUMH, comments that “Stillbirth is a tragedy for families and can have long lasting psychological, social, spiritual and financial impact. How people are cared for at the time of their loss can influence their overall experience and wellbeing. Having respectful maternity services that include good quality bereavement care can reduce the negative impact for parents and families. Although the impact of stillbirth mostly affects women and their families, caregivers, communities, and health services are also affected.”

Figures presented in the Lancet Series show that Ireland now ranks 17^th out of 186 countries in the world with a stillbirth rate of 2.7 stillbirths per 1,000 total births after 28 weeks of pregnancy. The National Perinatal Epidemiology Centre’s 2013 report showed that from 69,146 births in Ireland, 301 infants were stillborn. https://www.ucc.ie/en/npec/publications/. It is important to remember that this loss of life has a huge impact on families and caregivers and places a significant burden on both maternity services and wider society. The Lancet Ending Preventable Stillbirth Series calls upon all high-income countries to set and meet targets to close equity gaps for parents and use data to track and prevent stillbirths.

Follow NPEC on Twitter: @NPEC_UCC

HASHTAG: #endstillbirths

Minister for Skills, Research and Innovation, Damien English TD, announced Professor Geraldine Boylan and Professor Louise Kenny as the Science Foundation Ireland Joint Researchers of the Year 2015 at the SFI Science Summit in recognition of their global leadership in reducing the burden of disease and disability associated with the period just before and after birth. The SFI Researcher of the Year award “recognises the accomplishments of an SFI funded researcher who has contributed significantly to the Irish research community in their career and/or who has achieved exceptional research outputs in the last 12 months”.

This award was a first in two respects: the first time it has been given as a duo, but also the first time it has ever been award to a woman. Professor Mark Ferguson, Director General of Science Foundation Ireland and Chief Scientific Adviser to the Government of Ireland, added: “It is particularly apt that they are the first female recipients; INFANT is unique in that it’s being led by two women and encouraging junior female faculty at the centre is a priority for both of them.”

Presenting the award to the Professors, Minister English said: “Professors Boylan and Kenny are leading the way in perinatal care and research and they thoroughly deserve to receive this award for the outstanding work they have done and continue to do.  The Professors and their team at the INFANT Centre in Cork are developing solutions to address some of the most commonplace complications of pregnancy and the most significant problems for new-born babies.  Both of the Professors bring insights from their clinical practice to research, translate scientific advances to the bedside and cotside and are opening up markets for companies who now appreciate the scale of unmet clinical need.”  

Accepting the award, Professor Geraldine Boylan and Professor Louise Kenny said: “Every single day, somewhere in the world over 800 young women die as a direct result of pregnancy or childbirth, and in the same 24 hour period over 15,000 babies will be stillborn or will die within days of birth. Many millions more who survive will live with long-term disability. Perinatal research has lagged behind other research areas both in terms of investment and consequently in terms of progress. The support of Science Foundation Ireland, University College Cork, and the Irish government is helping our outstanding team at INFANT to reverse this trend.  It is hugely satisfying to see the results of our work making a difference to real women and babies’ lives on a daily basis.”

The Professors paid credit to the SFI for ‘bucking the trend’ and supporting INFANT. Thanking the INFANT team, the professors noted that, “Babies are born anytime day or night, on holidays, weekends, birthdays,” she said. “It is very likely that at this very moment one of our team is in the maternity hospital, maybe talking to a parent, possibly getting some consent for research, possibly taking [a blood sample] from a baby who has been delivered and is in a critical condition.” In tandem with this, they both paid special thanks to the parents of babies who take part in studies: “their altruism and selflessness is inspiring and deeply humbling for us”.

Both Louise and Geraldine are passionate about attracting women to science and hope that their success will  inspire young women contemplating a career in science or medicine. Kenny highlighted the benefits of working together with Boylan to run INFANT. They have been close friends and colleagues for nearly a decade and have co-directed for the last two years. “Directing a research centre can be very challenging and can occasionally be very lonely,” Prof Kenny said, “I am blessed every day by being able to manage the INFANT centre with one of my closest friends and colleagues. I can say it is often challenging but never lonely”.

PRIMARY SCHOOLS

INFANT researchers will be visiting schools in Cork with Blood & Brains – a mix of the “Bloody Detectives: Mystery Molecules” hands-on workshop and “Electric Brains: Mind Control” demonstration.

Find out what blood is made of, solve mysteries of hidden clues and protect the evidence!

Discover how these mystery molecules are helping us save lives of mums and babies.

THEN

See your brain light up as it is full of electricity! Discover how it works and learn how we can trick it!

Your brain operates everything in your body: it can move your own arm, but can you use it to move someone ELSE?

Visits are free but must be booked in advance via The Cork Science Festival 

SECONDARY SCHOOLS

For second level, join the INFANT researchers at CIT Blackrock Castle Observatory for their second level schools programme. Meet the scientists and engineers working right here in Cork in the Science Foundation Ireland STEMists area!

Visits must be booked in advance with CIT Blackrock Castle Observatory 

CAREER TALKS

INFANT volunteers with Smart Futures

If you’d like an INFANT researcher to visit your school, contact our outreach officer.

The 9th International Conference on Brain Monitoring and Neuroprotection in the Newborn will be held from 1–3 October 2015 in Cork, Ireland.

This conference will provide a state of the art forum for the most current and important research in Newborn Brain Monitoring and Neuroprotection.

With an international faculty of key opinion leaders, this conference provides a unique opportunity to hear brain monitoring and neuroprotection discussed comprehensively at a time when both fields are growing rapidly. Accompanying update workshops are designed to guide and provide a unique training experience. The Programme Committee are currently reviewing abstracts for inclusion in the main programme. We are delighted to have received a record number of submissions for 2015 and look forward to hearing these presentations.

Registrations are invited from professionals from all areas of expertise: neonatologists, neurophysiologists, neonatal nurses, research scientists, paediatric neurologists, allied health professionals, and more.Registration is now open and we would invite you to register. Early Bird Registration closed on 31 July.

The 9th International Conference on Brain Monitoring and Neuroprotection in the Newborn will be held at the Fota Island Resort. This is a premium destination hotel and conference facility located in the middle of lush green country side surrounded by world class golf courses, minutes outside Cork City which is served by an international airport.

This article was originally published on September 7th, 2015. For World Preeclampsia Day, May 22nd, 2017, read about INFANT’s research in preeclampsia prediction. 

Award for Preeclampsia Research

Ground-breaking work on preeclampsia, a life threatening complication of late pregnancy, has earned researchers in Cork a major award from the American Heart Association.

The international award is a first for Irish researchers and also a first for pregnancy research.  The scientific study has been announced as top paper for 2014 in the category of clinical science in Hypertension, the journal of the American Heart Association. The research was carried out by INFANT (The Irish Centre for Fetal and Neonatal Translation Research) based in UCC and the Cork University Maternity Hospital.

The SCOPE (Screening for Pregnancy Endpoints) research is led in Ireland by Louise Kenny, Professor of Obstetrics at University College Cork, Director of the INFANT Centre and Consultant Obstetrician and Gynaecologist at Cork University Maternity Hospital.

The SCOPE project is an international study that aims to develop screening tests to predict and prevent the major complications of late pregnancy, such as pre-eclampsia. Pregnancy can be a dangerous time for millions of women worldwide: pre-eclampsia claims the lives of more than 70,000 women and over 500,000 infants every year.

Prof Kenny explains the reasons behind the study, “it’s about saving the lives of mothers and their babies: that’s why we get up every morning, that’s why this is so important.”

Life-Threatening Complications

This potentially deadly disorder could be prevented with the development of a test that could identify women who are at greatest risk, and the SCOPE study aims to do just this. It will develop an early pregnancy screening test that will offer first time mothers accurate risk assessment. The intensity of prenatal care can then be matched to each woman’s personal risk profile: preventative therapies can be offered if they are needed.  Professor Louise Kenny said, “Our goal is to save the lives of affected mums and babies by reducing and eventually preventing the life-threatening complications associated with pre-eclampsia.”

The American Heart Association award is for the group’s first major publication. In this study, 75 putative biomarkers of interest were investigated. None, alone nor in combination, provided a robust enough test, providing further support for Prof  Kenny’s work to develop novel biomarkers specific for pregnancy using the new technology.

Predicting Problems

A follow on study called IMPROvED is recruiting pregnant women in the Cork University Maternity Hospital  and across Europe, contributing to one of the world’s largest and most detailed “biobanks” with samples given by the mums and babies.

“The next phase will be to combine clinical information and our pregnancy specific biomarkers to develop the most effective system for predicting problems in pregnancy. The final step is to turn this into a prototype blood test” says Louise. “Hopefully mothers and babies should benefit from the new screening test within the next five to ten years.”

“Fantastic Achievement”

The researchers invite first time mums who are less than 17 weeks pregnant to get involved in the study  – if interested contact the IMPROvED team by email at improved@ucc.ie

Graham Love, the Chief Executive of the Health Research Board who funded Professor Kenny’s initial involvement in SCOPE said:

“This is a fantastic achievement by Prof Kenny and her research team. It’s both a testament to the quality of Ireland’s health researchers that they can win such a prestigious international award, and also a validation of the HRB’s efforts to foster a dynamic culture of research and innovation at the heart of our health care services.”

Prof Kenny’s original Clinician Scientist Award was then the largest grant made to a single project in Ireland at €1.7 million.  It enabled over 1,600 Irish mothers and babies to participate in the SCOPE project and involved 5,700 first time pregnant women in four countries.

We are thrilled that the INFANT team has reached the final stage of the international Saving Lives at Birth Grand Challenge.

This funding programme is dedicated to identifying and scaling up transformative prevention and treatment approaches for pregnant women and newborns.

The team are at the final to compete for funding to develop our Newborn Brain Audioscope innovation. The audioscope is a portable device that will allow healthcarers to hear brainwaves and assess the brain health of babies.

Why do we need to assess brain health?

Each year, there are 2.9 million neonatal deaths worldwide. 1 million of these are due to birth asphyxia: a lack of oxygen around the time of birth. 98% of these deaths occur in low/low-middle income countries (LMIC).  As a result, birth asphyxia accounts for 41 million “disability adjusted life years” (the number of years lost due to ill-health, disability or early death). Birth asphyxia is therefore one of the leading causes of mortality and morbidity in low-middle income countries. Of the children who survive birth asphyxia, 1 million of them develop neurodevelopmental disorders, including learning disabilities, intellectual disabilities, and cerebral palsy.

What can be done to prevent this?

Although neurological problems are more likely to happen in the early neonatal period than at any other time of life, it is the exact period when there is the least brain monitoring. Many of these neonatal deaths and lifelong disabilities could be prevented if the babies’ brains were monitored. Currently, the only way to monitor the brain is to use expensive EEG machines that require high levels of skill to acquire and interpret signals.

The development of the Newborn Brain Audioscope would change this. The device will follow the conventional stethoscope design – a hand-held tool with a sensor pad to be applied to the baby’s head that will enable any kind of healthcare professional to listen for activity through headphones. Babies that have suffered severe encephalopathy (brain disorders) often have absent brain activity in the first few hours of life or if they are suffering “fits” or seizures, this sound will be heard and interpreted easily by the healthcare professional using the same skills they use with a stethoscope.

The development of a portable and easily accessible device to assess brain functioning may revolutionise neurocritical care of newborns in resource limited settings.

We would like to call on your help to support this proposal with just a few clicks.

The team’s proposed project aims to develop a neurological “stethoscope” to help identify babies at highest risk of brain injury soon after birth. 85% of neonatal deaths worldwide occur in developing countries and a major cause is neonatal brain disorder due to asphyxia. EEG machines are expensive and the time and skills needed to acquire and interpret the signals are all obstacles to their use in the developing world. This project’s brain ‘stethoscope’ will be able to monitor brain function in a low-cost and simplified way, just as a conventional stethoscope is used to monitor heart beats and respiration. The results will enable us to deliver the best possible care and best outcomes for these babies.

HOW TO HELP:

The Grand Challenge includes a public voting forum for the People’s Choice Award where the public can vote online for their favourite project.  To vote for the project simply register for an account and then click the star on the project’s page.

Reaching the finals is an incredible achievement and securing the funding has the potential to save many newborn lives worldwide.

New research by INFANT researchers on the link between C-Sections and Autism Spectrum Disorder has been published. 

Autism spectrum disorder, a condition characterized by an inability to connect to other people and repetitive, often unusual behaviours, is thought to affect about 0.62% of all children. Although it is understood that the condition follows genetic lines, scientists do not know what causes ASD. There is a suggestion that it may be linked to perinatal factors, including a Caesarean delivery as children born by Caesarean section are about 21% more likely to be diagnosed with autism.

A new study by researchers at INFANT confirms previous findings, but are stresses that this relationship does not mean Caesarean births cause autism. Instead, they suggest that some unknown genetic or environmental factors may lead to both c-section delivery and the disorder.

Eileen Curran presenting the results at the European Congress of Epidemiology in Maastricht, The Netherlands on 25 June at the opening plenary session.

Led by Dr. Ali S. Khashan, the researchers set out to investigate the relationship between the mode of obstetric delivery and autism. Looking at data from the Swedish registry, they focusing on all single, live births between 1 Jan 1982 and 31 Dec 2010. Following the children until diagnosis of autism, migration, death or the study end date. The full cohort consisted of about 2.7 million children and 1% (precisely 28,290) of these children were diagnosed with autism.

Nearly 80% of the children were born by unassisted vaginal delivery, 7.3%  by assisted vaginal delivery (use of forceps or a vacuum device), 6.1% by elective section delivery and 6.5% by emergency section. Exploring the datasets, children born by elective cesarean section were 21% more likely to autistic.

When further comparisons and calculations were made, analsying the mode of delivery among more than 13,400 pairs of siblings where one child was diagnosed with autism and the other was not, the association did not hold up. They concluded that any link was likely due to unknown genetic or environmental factors and not because of how the child was delivered.

Based on the data, there is no evidence that birth by Caesarean section causes ASD. Because the association between birth by Caesarean section and autism did not persist in the sibling control analysis, we can conclude that there is no causal association. 

The overall risk of ASD is very small and our researchers’ work suggests that most — if not all — the risk isnot to do with the Caesarean section: this should be reassuring for parents. Anyone concerned about their pregnancy or their baby should speak to their health care provider.

The work has been featured on news websites such as: Huffington Post; DailyRx; MedPage Today; Doctors Lounge; Medical Daily; and Science Daily.

Source: Curran EA, Dalman C, Kearney PM, et al. Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder A Population-Based Sibling Design Study. JAMA Psychiatry. 2015.

The INFANT Centre and College of Medicine and Health are delighted to host INFANT’s Inaugural Research Day on June 16, 2015.

Better Outcomes for Maternal and Fetal Health

Click here for FULL Research Day Programme

Keynote Speakers:

Prof Lucilla Poston, King’s College London

Prof Charles Lockwood, University of South Florida

Prof Ben Stenson, Royal Infirmary of Edinburgh

Prof Neil Finer, University of California

Tues 16 June 2015   09.00 – 17.30 – Registration from 08.00

Brookfield Health Sciences Complex, UCC

The Royal College of Physicians of Ireland will award 6 CPD Points to attendees

Free Registration on EventBrite

A report in the Irish Times highlights studies that seek to meet the needs of tiny babies in neonatal intensive care units.

The article explores work being done at INFANT to test a cot-side monitor to detect brain seizures in babies in the NICU.

“Some babies are at risk of having brain seizures, but you can’t always tell just by looking at them that they are seizing. And if we don’t know when they are seizing, we don’t know when to treat them,” explains Geraldine Boylan, professor of neonatal physiology at UCC and a director of the Irish Centre For Fetal and Neonatal Translational (INFANT) research centre.

To alert clinical staff to a problem, the researchers in INFANT have developed specialised software that can track the electrical signals coming from small electrode pads placed on the baby’s head: it automatically detects when a seizure is starting, and sends an alert.

The work, which was funded by agencies such as the Health Research Board, Science Foundation Ireland and the Wellcome Trust, has led to a clinical trial of the technology in NICUs in Cork, Dublin, London, Sweden and the Netherlands.

“We would like this technology to be next to every cot in every NICU in the world, keeping an eye on these babies’ brains around the clock, and we hope that it will allow brain monitoring in these tiny babies to become as commonplace as monitoring their heartbeat.”

Consent and ethics – The Role of the Family in Research

One of the most important requirements for clinical research studies in babies is getting informed consent from parents when their babies are in the NICU.

This can be difficult and it needs to be handled sensitively by the research team, but it is important to stress that often the parents and families want to help – they are fantastic, and we can’t thank them enough for their engagement at a really worrying time for the family.

Without the participation and support of the families, these clinical trials cannot happen.

It is quite stressful to consider participation in a trial when your baby has been or will be born prematurely. However, people understand that the startling improvements in neonatal medicine in recent decades are due to clinical research, and clinical trials in particular. Families support this research for altruistic reasons: they want to improve medical care for babies and families who will find themselves in their situation in the future.

People correctly debate the ethics of doing research in babies and children, but what they don’t talk about quite so much is the ethics of not doing research in babies and children. If you make it difficult to do research in babies, you end up treating them with therapies that are far less well tested than in other age groups. We do these studies to try to improve the care of babies everywhere, not just in an individual hospital or in Ireland.

On Thursday Novermber 13th, Dr Ali Khashan organised INFANT’s hosting of a public forum on C-sections. The event was attended by over 200 people. Speakers included clinicians, patients and INFANT researchers. Details of this and future related events can be had by contacting Ali by emaila.khashan@ucc.ie