INFANT is a leading research and innovation centre helping to improve the lives of mothers and babies. Marjorie Brennan visits the Cork-based facility.
LIKE any parent, Professor Geraldine Boylan’s eyes shine as she talks about her baby. In this case, Boylan’s pride and joy is the Irish Centre for maternal and Child HealthResearch — or INFANT for short — of which she is director.
Since its official establishment in 2013, the centre has become a focal point for world-leading research and innovation, growing from a team of five to more than 100 staff, and incorporating a dedicated paediatric clinical research unit, an internationally recognised biobank, a world-leading data hub and other clinical research infrastructure in obstetrics and neonatology.
I meet Prof Boylan at the paediatric academic unit at Cork University Hospital, a state-of-the-art facility which opened last year, and the first of its kind in Ireland. The unit is one of three INFANT bases in Cork, along with Cork University Maternity Hospital and the UCC campus. The brightly painted corridors are dotted with murals and behind the office doors are more than 60 staff working on improving health outcomes for mums and children, from infancy to adolescence.
The scope of research carried out by the centre is impressive, ranging from predictive screening for pre-eclampsia to pioneering therapy for peanut allergy and the harnessing of AI technologies to prevent seizures.
Boylan says INFANT is playing catch-up to a large extent because of years of under-investment in maternal and child health.
“This centre is basically starting from scratch in terms of research. The reason it probably wasn’t done before was that it was challenging — because let’s face it, there are two patients [mother and baby],” she says. “But just because it’s challenging doesn’t mean we shouldn’t do it. So if a mum has a complication in pregnancy, we want to get that mum involved in research because it’s the only way we’re going to figure out how to make things better down the line.”
The profound impact of research done at the centre on clinical practice is exemplified in a study carried out by INFANT, and funded by the Wellcome Trust, which involved the development of an algorithm for identifying seizures in babies.
That technology was more than 10 years in the making, which also illustrates another key component in the process — patience.
“The thing about impact in clinical research is it takes time. It has to be done carefully, slowly, painstakingly, in the right way. So we spent a lot of time developing that algorithm with our engineering team in UCC. We had to train it and test it and then we did a clinical trial across Europe. And the trials show that actually this algorithm detects two to five times more seizures then if you didn’t have it,” says Boylan.
Resilience is another word which crops up throughout my chat with Boylan — and it was needed even more when the Science Foundation of Ireland (SFI) decided last year not to renew funding to the centre when its initial six-year allocation came to an end in May. While Boylan says the decision was a blow, the SFI has recently carried out a site review which Boylan says went extremely well, and she is hopeful of further funding.
“INFANT exists because of SFI funding and they also gave us another grant for the infrastructure here, which weco-funded with UCC and philanthropy. We now have the facilities to assess children here when they come back — before we didn’t even have a lift and mums had to carry buggies up the stairs.
“Core funding is really important but we had a lot of other funding sources as well. So that meant that our work could continue.”
Researchers at INFANT are also breaking new ground in the area of pregnancy loss. The centre’s pregnancy loss research group is led by Dr Keelin O’Donoghue, who, like many of her colleagues, epitomises the phrase “if you want something done, ask a busy person”.
As we sit and chat in her office, her phone is constantly pinging but her good humour shines through as she assures me this is a relatively quiet day. O’Donoghue is also a practising obstetrician and gynaecologist and leads the development of NationalBereavement Standards in maternity Services.
“People think working onpregnancy loss is all about looking at the causes of miscarriage or stillbirth. But there is a huge range of work to be done in the area, from the experience in the hospitals, to investigation, to what you do in the next pregnancy, how you structure the services for all of those different types of loss, and also how we learn from the things that go wrong in more functional ways than we seem able to do at the moment,” says O’Donoghue.
Areas being studied by researchers include ectopic pregnancy, early miscarriage, new clinical practice around fatal fetal anomalies, the process of perinatal mortality reviews, risk factors for stillbirth and how maternal behaviours might be influenced.
“The group has also been funded by the Health Research Board to evaluate and audit recurrent miscarriage services nationally.
“It is really exciting because a lot of what we’ve done over the last six or seven years has been done on a shoestring in terms of funding post-doctoral scientists, clinicians and midwives to do this work,” says O’Donoghue.
She is also keen to ensure women have access to accurate and fact-based information around pregnancy loss, and has worked with the Irish Hospice Foundation in the development of a national website [pregnancyandinfantloss. ie] to this end.
O’Donoghue’s work rate is somewhat awe-inspiring but she acknowledges the efforts of the entire team involved, from clinicians to researchers to parents. “Fortunately, I like work and I like doing lots of different things. And, yes, I’m the person leading it but I’m lucky in that I have a committed group of people who all want to do this. We started small and have grown to the point were we are one of the leading groups in this area and are now recognised internationally as such, which is great.”
At the heart of it all, in the bustling corridors of the maternity hospital, is the office of neonatologist Professor Gene Dempsey, who oversees theclinical trials that take place on the ground in the maternity and neonatal units. He is deep in concentration writing up a study and, like Boylan and O’Donoghue, his dedication to INFANT is palpable in the way he speaks about the centre’s research.
“INFANT has been central to a number of the studies that we’ve conducted here — it has given us the infrastructure, resources and expertise to ensure trials are conducted appropriately,especially in such a vulnerable population of infants. Having those resources mean as a clinician you can just focus on the project, what the problem is, and try to deal with that,” he says.
One of the more recent projects Dempsey has overseen is the utilisation of music therapy toassist with pain reduction in babies having blood-letting procedures.
“They were randomised to have music — Brahms Lullaby — or no music, while having sucrose in both arms. We measured their brain activity and while there wasn’t a statistically significant difference, there was a reduction in the [stress hormone] cortisol values in the pre-term entrants from that exposure to music. So, that is interesting, and that was just one simple project that we’re able to run on the ground here.”
Other ongoing studies include one looking at the possible benefits of delayed cord clamping in preterm infants and another on the process of measuring oxygen levels in the brains of pre-term infants.
Dempsey pays tribute to the parents who consent to their babies being enrolled in research studies, often in times of great stress and turmoil for them personally. “The parents are fantastic on so many levels, and sometimes the altruism that is shown is heartbreaking. But there is a strong urge there, even among parents who are undergoing a very traumatic experience, to give back and help those who come after them.
“We have to be explicit in the consent form, which includes a section that says ‘your baby may not benefit from this trial’. And the parents will say, ‘but it might actually benefit another baby into the future’. And I find that amazing.”
Boylan echoes this sentiment and also acknowledges the support of the wider community in Cork. “This centre is known over the world for the work that it does and it is something to be really proud of. I do want to make sure the people of Cork know that they have been part of our story and I want to thank them for their support and participation, often in very challenging circumstances.”
And while the centre has achieved so much, Boylan is clear about the ongoing commitment of all involved to keep working to ensure better health outcomes for women and their babies. “We are doing a lot but we have a lot more to do. But you tend to find the women and the men that are working in this space, we’re all pretty passionate and determined. Because you have to be — it is 24/7.”
There is a strong urge there, even among parents who are undergoing a very traumatic experience, to give back and help those who come after them