Brain damage at birth: could a sedative boost the benefits of existing treatment?
This research was completed on 31 May 2014
Published on 29 October 2010
Almost a million of the world’s under fives die each year and many others develop devastating, lifelong disabilities – including cerebral palsy and epilepsy – because of a problem called birth asphyxia, which can cause brain damage.1-3 Cooling a baby’s temperature down for three days after birth can give him, or her, a better chance of surviving and escaping disability, but this doesn’t help all babies. Researchers are investigating whether a sedative might boost the benefits of cooling and improve babies’ chances.
What's the problem and who does it affect?
Devastating loss just after birth
Birth asphyxia is a major problem worldwide. The World Health Organisation estimates it to be one of the top six causes of death in children under five.1 Babies who survive are at high risk of developing serious, lifelong disabilities.
Babies with birth asphyxia are deprived of oxygen at around the time of birth. Their health and their life are put at risk if the lack of oxygen damages their brain or other vital organs. The babies can have a range of learning, memory and behavioural problems at school, and up to 40 per cent have long-term disabilities or cerebral palsy.4
Many different things can cause birth asphyxia, including high or low blood pressure in the mother, problems with the placenta, compression of the umbilical cord and breathing difficulties in the newborn, though sometimes the cause remains unknown.
Even if the cause is found, birth asphyxia tends to come totally out of the blue – a traumatic end to what is usually an apparently uneventful pregnancy with a previously healthy baby.
What is the project trying to achieve?
Could a sedative help protect babies?
A recent breakthrough in treatment has brought some benefits to babies who develop brain damage after suffering from birth asphyxia. Cooling a baby’s temperature down, by about for 3-4°C, for three days after birth can give him, or her, a slightly better chance of surviving and escaping disability.
However, cooling does not benefit every baby. For every eight babies treated, one is saved from dying or developing a disability.5 More than half of the babies who receive treatment still die or develop a disability.5
We urgently need a way to add to the benefits of cooling. The researchers believe that giving babies a sedative, called dexmedetomidine, might do just that. Evidence suggests this sedative can protect against the sort of brain damage that is caused by oxygen deprivation and a poor blood supply. Its beneficial properties include reducing inflammation and stopping cells from dying.
The researchers are investigating the benefits of adding dexmedetomidine to cooling in a laboratory model. They are assessing the safety of treatment and studying how effective it is.
What are the researchers' credentials?
|Project Leader||Dr N J Robertson FRPCH PhD|
|Location||Neonatology Department and Perinatal Brain Repair Group, Institute for Women's Health, University College London, Department of Anesthetics, Intensive Care and Pain Medicine & Department of Leucocyte Biology, Chelsea and Westminster Hospital, Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, Institute of Neurology, University College London and Department of Medical Physics and Bioengineering, UCLH NHS Foundation Trust, London|
|Grant awarded||29 July 2010|
|Start date||1 November 2010|
|End date||31 May 2014|
|Grant code||SP4553, GN1775|
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The project leader, Dr Nicola Robertson, leads a research group at University College London whose work has been central to the development of cooling as a treatment for newborn babies. Cooling has become the standard of care for babies in the UK who have developed brain damage after suffering birth asphyxia.
Dr Robertson’s group has developed a laboratory model; in the past this model was important in showing cooling was safe and effective and could be used to treat newborn babies. Now the researchers’ unique model is vital to the success of this project, which seeks to boost the benefits of cooling.
Several eminent researchers are taking part in this study, providing a critical mass of expertise in how newborn babies’ brains function in health and disease. The researchers have access to state-of-the-art facilities, including a £3 million magnetic-resonance-imaging (MRI) system, with world-class physics support.
Who stands to benefit from this research and how?
Giving babies a better chance
The researchers aim to help babies who have developed brain damage after being deprived of oxygen at birth – after suffering birth asphyxia. In industrialised countries like the UK, around one to two babies in every thousand born alive at full term suffers brain damage.6 In some other parts of the world, many more babies are affected – the problem is ten to 20 times more common in sub-Saharan Africa, for example.7
Cooling already improves a baby’s chances, but more than half of the babies who receive treatment still die or develop a disability.5 The researchers are finding out whether the sedative drug, dexmedetomidine, has the potential to boost the benefits of cooling and protect more babies.
If the results are positive, the researchers hope to run clinical trials in newborns as soon as possible. As dexmedetomidine is already used to treat children in different circumstances, trials could begin in a relatively short time.
The death and disability caused by birth asphyxia brings immeasurable loss just at a time when new life is eagerly anticipated. The researchers hope their work will give new hope to all concerned.
- Bryce J, Boschi-Pinto C, Shibuya K, Black RE, WHO Child Health Epidemiology Reference Group. WHO estimates of the causes of death in children. Lancet 2005; 365(9465):1147-52.
- Lawn JE, Kinney M, Lee AC, Chopra M, Donnay F, Paul VK, Bhutta ZA, Bateman M, Darmstadt GL. Reducing intrapartum-related deaths and disability: Can the health system deliver? Int J Gynaecol Obstet 2009;107 Suppl 1:S123-40, S140-2.
- World Health Organization. The World Health Report 2005 - make every mother and child count. Chapter 5 (Newborns: no longer going unnoticed). (http://www.who.int/whr/2005/whr2005_en.pdf).
- Marlow N, Rose AS, Rands CE, Draper ES. Neuropsychological and educational problems at school age associated with neonatal encephalopathy Arch Dis Child Fetal Neonatal Ed 2005;90:F380–F387. doi: 10.1136/adc.2004.067520
- Edwards AD, Brocklehurst P, Gunn AJ, Halliday H, Juszczak E, Levene M, Strohm B, Thoresen M, Whitelaw A, Azzopardi D. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data. BMJ 2010; 340 (c363. doi:10.1136/bmj.c363).
- Pierrat V HN, Liska A, Thomas D, Subtil D, Truffert P; Groupe d'Etudes en Epidemiologie Perinatale : Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: Population based study. Arch Dis Child Fetal Neonatal Ed 2005 90:F257-261.
- Lawn J, Shibuya K, Stein C: No cry at birth: Global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ 2005; 83:409-417.