A new international trial led by University College Cork (UCC) will evaluate cot-side technology to monitor brain seizures in high-risk newborns. Claire O’Connell caught up with researcher Prof Geraldine Boylan, professor of neonatal physiology at UCC, to find out more about the technology and how it will link in with a major new centre for research into pregnancy and newborn health.
How do you know when a tiny baby is having a brain seizure? A lot of the time, you don’t, which makes it difficult to know when the baby needs treatment. That’s why Boylan and colleagues at UCC have developed technology that can automatically monitor brain waves in vulnerable babies in hospital.
“If you look at the devices that are monitoring these babies, they are looking at heart rate and blood pressure, but there’s nothing keeping track of the brain activity,” says Boylan, who directs the Neonatal Brain Research Group at UCC. “So we have developed an algorithm that can analyse the readings from continuous EEG monitoring and signal when there is a problem.”
She stresses that most babies do not need such monitoring, but for babies who are at risk of brain injury, knowing what is going on could mean more timely intervention to help them: “We hope that by automatically detecting the seizures, which often have no obvious outward symptoms, the clinical staff will be able to take measures to help the babies and reduce the potential impact or damage of those seizures.”
Putting seizure detection to the test
Boylan has been working for several years with a team of clinicians, engineers, nursing staff, parents and babies to develop the seizure-detection technology, and now it’s crunch time. Next month, an international trial will kick off to evaluate the cot-side device and algorithm in neonatal intensive care units in Cork, Dublin, London, Sweden and The Netherlands.
“We want to find out in a clinical setting, if having this technology by the cot-side means that seizures are being detected earlier and treated faster,” says Boylan. “We have tested the algorithm with so much data that we have collected over the years, and now we get to see does it work – at the cot-side in the middle of the night, at 5am when no-one is around, this technology has to do the job.”
Funded through a Wellcome Trust Strategic Translational Award led by Boylan and Dr Liam Marnane in UCC, the study will also ensure that the technology complies with medical device regulatory requirements, she adds. “At the end of this trial we want to have a product that is ready to license and be used around the world.”
The search for better treatments
While it’s important to be able to detect when a seizure is happening, we also need better treatments in newborns, according to Boylan.
She hopes the seizure-detection technology can be used in future trials that evaluate treatments for seizures, such as the major EU-funded project NEMO. And Boylan is working with Dr David Henshall at the Royal College of Surgeons in Ireland to look at lab models of epilepsy that mimic the seizures that happen in newborns, with a view to identifying new avenues to treat them. “We are working on the molecular level to look for good therapeutic targets for epilepsy and seizures,” she explains.
New centre due
The seizure-detection research is expected to form part of a major new centre in Cork, INFANT (the Irish Centre for Fetal and Neonatal Translational Research). Due to launch later this year, it puts the focus on monitoring health in pregnancy and newborns and is one of seven new academic-industry centres that Science Foundation Ireland announced last month in a total package of funding worth around €300m over six years.
Boylan will co-direct INFANT with consultant obstetrician Prof Louise Kenny, who is studying complications of pregnancy, including intra-uterine growth restriction and pre-eclampsia. Through Kenny, Cork is involved in the international SCOPE study, which is looking for early markers in the blood that signify a woman is at risk of developing pre-eclampsia later in the pregnancy.
Bringing the perinatal research together under INFANT is a long-held dream, according to Boylan, who explains that the centre will be homed in two new, purpose-built facilities – one on campus in UCC and the other at Cork University Maternity Hospital, where the seizure-detection algorithm has been developed.
“The way it has worked out is fantastic and we have such a wonderful interdisciplinary team of researchers in INFANT – some of us are working at the point just after the babies are born and others are looking at the period before birth, particularly at some of the maternal factors that might impact on development and outcome,” she says. “So we want to be able to predict which pregnancies may have difficulties, detect which babies are at risk of developing brain problems and their severity, and ultimately we really want to be able to help prevent some of these problems ever happening. In that sense the research team in INFANT provides the perfect synergy to address these challenges.”
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