Our January Researcher in Focus is Dr. Aisling Garvey. Aisling is a National Children’s Research Centre funded Clinical Research Fellow based in the Infant Centre at University College Cork, working under the supervision of Prof. Eugene Dempsey, Prof. Deirdre Murray, and Prof. Geraldine Boylan.
Aisling is working on the MONItOr Study – “Multi-modal Assessment of Newborns at Risk of Neonatal Hypoxic Ischaemic Encephalopathy” study.
Neonatal Hypoxic Ischaemic Encephalopathy (HIE) is a type of brain injury (encephalopathy) caused by interruption of the supply of blood (ischemia) and oxygen (hypoxia) to a baby’s brain. It is one of the most serious complications that can affect full term babies.
HIE is estimated to occur in 1-3 of every 1000 live births resulting in the death of one million babies worldwide each year. For babies that survive, 20-40 % will be left with long term disability, including cerebral palsy, seizures, learning disability, hearing or visual loss.
Currently, HIE is graded into mild, moderate and severe cases based on a clinical examination, Apgar scores (a scoring system based on a baby’s heart rate, breathing, muscle tone, reflex responses, and colour), and level of acidosis (a decrease in the pH of blood). These grades are used to identify babies who will require therapeutic hypothermia to treat the brain injury.
As Aisling explains “Therapeutic Hypothermia or Cooling therapy is now standard of care for babies with moderate to severe HIE. It involves lowering the baby’s temperature to approximately 33.5°C for 72 hours followed by slow rewarming. Cooling therapy has led to a significant improvement in neurodevelopmental outcomes in babies, but to be effective, it must be initiated within 6 hours of birth”.
Cooling therapy is not recommended for babies with mild HIE, due to a perception that the risk of disability is low in this group. However, as Aisling states “recent studies have shown that 35 % of babies with mild HIE have significant disability on follow-up and their cognitive outcome at 5 years is the same as those with moderate grade HIE at birth”.
These studies suggest that the current criteria for identifying which infants have a significant brain injury and require cooling therapy are inadequate. New tests that can rapidly identify infants who have sustained a significant brain injury and who will benefit from cooling therapy are required.
In the MONItOr study, Aisling aims to identify more rapidly and accurately infants at highest risk of brain injury and poor long-term outcomes using a combination of clinical assessment, the measurement of blood biomarkers of brain injury, and the measurement of brain activity.
As she explains “We are examining very early detailed monitoring of brain activity, oxygen levels in the brain, measures of how well the heart is pumping, along with chemicals and proteins in the baby’s blood. These in combination with the clinical history will allow us to identify those infants who will benefit from cooling. This is the first study combining all these investigations in the same group of infants with brain injury, trying to identify the markers that best identify the babies at risk of developmental problems. The results of this study may help to improve our diagnosis in the future. If we can identify these babies earlier, we can start treatment earlier and improve their long-term outcome”.
Aisling’s interest in research began during medical school “My interest in research began in medical school as part of my Final Year Project in University College Cork which allowed me to raise awareness about correct medication use in children. I have been involved in many research studies and quality improvement projects throughout my training and have been very lucky to have wonderful supervisors and mentors along the way who have shared their expertise and helped me to develop my skills. Neonatology is an evolving speciality which grabbed me from day one. There is a constant drive within the discipline to develop better ways of caring for babies and improve their outcomes”.
Aisling would like to thank the NCRC and CMRF for their investment in paediatric research in Ireland “The NCRC and CMRF are wonderful organisations. I have seen first-hand the advances that have been made in Neonatology and Paediatrics thanks to research and the NCRC and CMRF have been instrumental in improving child health in Ireland. I know how hard the NCRC, CMRF and general public work to raise the money that sponsors projects like this and don’t for a second take it for granted that I was fortunate enough to receive one of the Clinical Fellowships. I will continue to build on the skills and expertise I have gained throughout this fellowship and also pay it forward to the next wave of junior doctors and students to try to improve our care of sick babies in the future”.
More information on Aisling’s research can be found through the following links:
Garvey AA, Pavel AM, O’Toole JM, Walsh BH, Korotchikova I, Dempsey EM, Murray DM, Boylan AG. Neurophysiological alterations during the first 6 hours in infants with mild Hypoxic Ischaemic Encephalopathy. 3rd Congress of Joint European Neonatal Societies (jENS 2019). Poster 78. Pediatr Res 86, 1–64 (2019)
Garvey AA, Dempsey EM. Applications of near infrared spectroscopy in the neonate. Curr Opin Pediatr. 2018 Apr;30(2):209-215. (Pubmed)