Currently, treatment includes inserting a very small tube, squirting the medication into their lungs and then removing it. As part of the trial, clinicians are instead administering surfactant using a small mask that is like a soft scoop that the baby sucks on. It is less invasive and easier to use. “We’re comparing these two methods.” Another international multicentre trial is trying to fix a problem for tiny preterm babies in which a blood vessel close to the heart fails to close and causes cardiovascular problems. Medication that can close the vessel includes using paracetamol and ibuprofen individually, but they don’t always work. “This trial will try both of them together,” says Eveline. She says it is important to contribute to international research, even if the ward only studies 20 or 25 patients. “If we all contribute around the world, we will have a much bigger group and will be more certain that the results we are seeing are true.” Another international multicentre trial involving very premature babies aims to compare different levels of humidification in their cribs. This study is examining how different temperatures could impact skin injury, infection and brain injury. Eveline says that when she began her training in 2002, clinicians were unsure about resuscitating babies at 24 weeks, whereas they are now looking after babies at 22 weeks with a survival rate of around 60 to 70 per cent. “As we push that boundary down, we are getting more and more immature babies, so we need to fine- tune the technology that we use to look after them, and we think that potentially using higher humidity is better for them,” she says. However, there are challenges – more warmth and moisture fosters bacterial growth, and the condensation inside the incubator means you can’t see the baby. “There are many practical aspects that we need to figure out.” Research in neonatal care is an ethically complex area. However, Eveline says for most trials, there is an 80 per cent to 90 per cent consent rate. “When parents arrive here with their baby, I think it becomes very obvious that we are such a technical specialty, and we need to do research to push this ahead. Many know that had their baby been born 20 years ago, they wouldn’t survive, but now they do because we’ve done the research before.”
The monthly “CPI Club” where staff meet to discuss grassroots innovation in care.
She says the field needs long-term research to determine whether an intervention is a good idea or not. “What often seems to be a good idea in the short term might be a terribly bad idea in the long term,” she says. For Eveline and her team, the message is clear: progress in neonatology depends on steady, collaborative research. Each study, no matter how small, adds to the evidence that shapes care for the most vulnerable patients. As Eveline puts it: “Babies need research”. How neonatal research is making a difference As much as oxygen is a good thing for babies, valuable neonatal research has revealed that occasionally it can be toxic. The American singer and songwriter Stevie Wonder was born six weeks premature in 1950, and lost his sight from having too much oxygen in his incubator, which damaged his retinas. The condition is known as Retinopathy of Prematurity (ROP), a disease where retinal blood vessels develop abnormally. “We now know we need to limit the amount of oxygen we give babies – enough for them to breathe but not too much because the eyes could get damaged,” says Eveline.
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