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What did the project achieve?
“Our findings will help to improve accurate prediction of how children who experienced birth asphyxia will do in the long-term – and the difficulties they may face. This is very important when families are being advised early on about what may happen to their child as they grow up,” says Professor Brigitte Vollmer of the University of Southampton. “We hope our findings will also help doctors, healthcare and education professionals to identify children who need support at school and in everyday life, and what type of support they need.”
Birth asphyxia – a lack of oxygen and/or a reduced blood supply to babies’ brains around the time of birth – can lead to hypoxic-ischaemic encephalopathy (HIE). A treatment called cooling therapy can save babies’ lives and reduce the risk of brain injury and subsequent severe disability, but little is known about the effects of HIE on children’s long-term brain development, learning and behaviour.
The researchers are carrying out a long-term study focused on children treated for HIE who do not develop severe neurodisability (cerebral palsy). Their previous findings indicated these children are at an increased risk of behavioural problems at two years of age. In the current study, they have followed up with around 80 of these children, aged six to eight years old, conducting learning and behaviourial assessments and brain scans to compare their school progress, social skills and quality of life with children who did not have HIE.
“So far, we have found that these children, who have not developed cerebral palsy, overall do well when they get to school age, but that they have more behaviourial issues, and this is partly affected by their parents’ mental well-being,” says Professor Vollmer. “We also found out that early brain scans around the time of birth can accurately predict whether a baby will develop cerebral palsy, but have limitations in predicting behaviour and learning at school age in babies who do not.”
“There are different issues with behaviour at home and school, and this is important as it could affect how well children do at school. We have also found that some of our measures of behaviour at toddler age can predict some behaviour when these children reach school age.”
This research is providing much-needed knowledge on brain development and real-world outcomes for children with HIE who received cooling therapy, the majority of whom do not develop severe lifelong disabilities.
“Our funding from Action has made all the difference to what we now know about the long-term development of the large proportion of children who had HIE and were treated with cooling therapy, and who survived without developing cerebral palsy,” says Professor Vollmer.
This research was completed on
Every year, it’s estimated that around 1,000 babies in the UK will experience a brain injury called hypoxic-ischaemic encephalopathy (HIE) after being starved of oxygen around the time of birth.1,2 The standard treatment is known as cooling therapy – which, for many babies, is life-saving and reduces the risk of lifelong disabilities. Dr Brigitte Vollmer and her team are carrying out a study to gain a better understanding of the long-term impact of HIE on the lives of children who initially benefited from cooling therapy. Her results could lead to new ways to identify those who may benefit from early intervention, enabling improved support at school and in everyday life.
How are children’s lives affected now?
Birth asphyxia – a lack of oxygen and/or a reduced blood supply to babies’ brains around the time of birth – can have terrible consequences, including a brain injury called hypoxic-ischaemic encephalopathy (HIE). Tragically, babies with this condition can lose their lives or be left with long-term complications, like cerebral palsy.
“Thankfully, an effective treatment is available that involves deliberately lowering a newborn baby’s body temperature for up to three days before gradually warming them back up,” says Dr Vollmer.
Although cooling therapy saves many babies from death and severe disability, little is known about the long-term effects of early brain injury, HIE, on children’s everyday lives. Many who appear to have been spared of the most serious effects have neurodevelopmental problems such as learning and behavioural problems.
“We really need to gain a better understanding of how children who’ve survived HIE continue to develop throughout their childhood,” says Dr Vollmer.
How could this research help?
“Our goal is to improve our knowledge of the long-term effects of HIE on a child’s brain development, learning and behaviour – and develop ways to identify those who may benefit from additional support,” says Dr Vollmer.
By analysing information from routine assessments from a group of children treated for HIE who didn’t develop cerebral palsy, the researchers have identified that these children are at an increased risk of behavioural problems at two years of age.
“We now plan to follow up around 80 children, who are currently between six and eight years old, by carrying out learning and behavioural assessments and a brain scan,” says Dr Vollmer.
The team will then analyse these data – along with brain scans taken just after birth – to identify any differences in their school progress, social skills and quality of life compared with a similar group of children who did not have HIE.
“Ultimately, we hope to establish if brain scans combined with data from routine assessments early in infancy can predict how a child who had HIE and cooling treatment will progress in their everyday lives with a particular focus on skills and abilities that are important for school readiness and academic progress – enabling earlier identification of those who need extra support” says Dr Vollmer.
References
1. J.J. Kurinczuk, M. White-Koning, N. Badawi. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy Early Hum Dev 86, 329-38 (2010).
2. Office for National Statistics. Vital Statistics in the UK: births, deaths and marriages – 2018 update: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrati...
| Project Leader | Dr Brigitte Vollmer Dr.med PhD FRCPCH |
| Project Team | Dr Caroline J Edmonds PhD CPsychol CSci Dr Christine M Cornforth PhDDr Jacques-Donald Tournier PhD Dr Angela A Darekar PhD MIPEM Professor Ruth M Pickering BSc MSc PhD CStat |
| Project Location | Clinical Neurosciences, University of Southampton |
| Project Location Other | School of Psychology, University of East London, Department of Women’s and Children’s Health, University of Liverpool, Department of Biomedical Engineering, King’s College London Medical Physics, University Hospital Southampton, Primary Care and Population Sciences, University of Southampton |
| Project duration | 3 years |
| Date awarded | 20 November 2018 |
| Project start date | 1 March 2019 |
| Project end date | 31 January 2023 |
| Grant amount | £180,783 |
| Grant code | GN2759 |
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