Bleeds in a baby’s brain can cause lifelong disability

Within just a few days of birth, around a fifth of premature babies who are born 8 weeks or more too early suffer a haemorrhage – a bleed – in the fluid-filled spaces in the brain (the ventricles).¹ As the blood clots, it can obstruct the normal flow of fluid within the brain, causing increased pressure and enlargement of the ventricles, so called hydrocephalus.

Over half of the babies who suffer these brain haemorrhages go on to develop this swelling in the brain.^1,2,3,4 Sadly, some 90% of these babies develop serious, lifelong disabilities.^1,2,3,4 The list of possible problems is long and depressing; it includes cerebral palsy, developmental delay, epilepsy, deafness, blindness and permanent enlargement of the ventricles, ie permanent hydrocephalus.

Current treatment involves an operation in which a shunt is inserted, but no treatment has yet been shown to be entirely effective.^5,6 A shunt is a thin tube that diverts fluid from the ventricles to the baby’s abdomen. However, in such tiny babies, shunts often get infected or fail. Even when successful, they are not a cure, and most operated babies remain dependent on shunts for the rest of their lives. Better treatments are urgently needed.

Searching for a new treatment

The researchers’ objective is to find a new way to stop the interruption of fluid flow around a premature baby’s brain after he, or she, suffers a haemorrhage. In theory, this could prevent brain damage and stop so many babies from going on to develop disabilities.

When a new treatment is developed, it is important have experimental models that are as similar to the clinical situation as possible. In earlier work, also funded by Action Medical Research, the researchers developed a small experimental model, which they used to test out different drugs. Because that model is very small, a larger model is now needed before trials can begin in babies.

In this project, the researchers are therefore developing a larger model. They will choose the most effective drug from studies using the smaller experimental model. The researchers are experienced in this type of work. Cooling babies after they experience a lack of oxygen after birth is a treatment that was trialed in small, then larger models, followed by clinical trials in babies that have led to implementation of a new, effective treatment.

Professor Marianne Thoresen is a leading expert in developing ways to protect the newborn brain against injury. She led pioneering research that showed that cooling babies after they’ve experienced a lack of oxygen could protect the brain and improve outcomes. This is the first ever treatment shown to work.

Professor Thoresen is both a scientist and a clinical doctor looking after sick newborn babies. She draws on her expertise in both fields to develop ways to study human disease in the laboratory, and is known worldwide for this work.

The research team has all the expertise needed to carry out this project. They are well equipped – their lab has recently been enlarged and refurbished – and they work in close collaboration with clinicians who treat babies with water on the brain on a daily basis.

Hopes of reducing disability in premature babies

The researchers’ long-term aim is to find a new treatment that can help stop babies from developing hydrocephalus after they suffer a brain haemorrhage.

Several drugs are being studied in this project – the drug that shows most promise in the small model will go on to be examined in the larger model. If this drug reduces the occurrence of hydrocephalus, and has no adverse effects, the researchers plan to set up a clinical trial in premature babies. They hope their work will also make it easier to study the suitability of other potential treatments in the laboratory using these new models.

An effective treatment against the development of hydrocephalus could have a huge impact on the future lives of premature babies. It could help save lives and prevent the need for shunts, and help stop so many babies from developing lifelong problems, such as cerebral palsy, developmental delay, epilepsy, deafness and blindness.