Friday, 9 April 2010
First newborn in the world to receive xenon gas in a bid to prevent brain injury.
St Michael’s Hospital, part of University Hospitals Bristol NHS Foundation Trust, has become the first hospital in the world to successfully deliver xenon gas to a newborn baby in a bid to prevent brain injury following a lack of oxygen at birth.
This pioneering technique has been developed by Marianne Thoresen, Professor of Neonatal Neuroscience at the University of Bristol and Dr John Dingley, ABM University Health Board Consultant Anaesthetist and Reader in Anaesthetics at Swansea University’s School of Medicine. This study is being funded by Sparks, the children’s medical research charity.
In the UK, every year, more than 1,000 otherwise healthy babies born at full term die or suffer brain injury caused by a lack of oxygen and/or blood supply at birth. This can lead to lifelong problems such as cerebral palsy.
St Michael’s Hospital and the University of Bristol has pioneered new treatments for brain injury in babies since Marianne Thoresen first started cooling babies in 1998, showing that cooling babies after a lack of oxygen could reduce damage in the newborn brain. After her original laboratory work from 1995 showing that cooling after lack of oxygen reduced brain injury in animal models, clinical trials of cooling have now proven that mild cooling by only a few degrees for 72 hours is a safe and beneficial treatment. However, cooling only partially reduces disability and does not prevent it in all babies.
The search has been to find a second treatment that could be added to cooling to further reduce disability.
Professor Marianne Thoresen, says:
“Xenon is a very rare and chemically inert anaesthetic gas found in tiny quantities in the air that we breathe. In 2002 John Dingley and I realised the potential xenon and cooling might have in combination to further reduce disability. Over the past eight years, we have shown in the laboratory that xenon doubles the protective effect of cooling on the brain; however we faced the challenge of how to safely and effectively deliver this rare and extremely expensive gas to newborn babies.”
Dr Dingley has been developing equipment in Swansea for xenon anaesthesia in adults for over 10 years and has invented a machine to successfully deliver the gas to babies. His machine takes the exhaled gas, removes any waste products from it and re-circulates it to be breathed again without any loss at all to the outside air. Some types of specialist military diving equipment work in this way but it is very unusual to build a system small enough to work reliably in newborn babies.
Dr Dingley, says:
“A key design feature of this machine is that it is very efficient, using less than 200ml of xenon per hour – less than the volume of a soft drinks can. Xenon is a precious and finite resource and difficult to extract so it can cost up to £30 per litre. As ventilated newborns breathe many litres of air per minute, any xenon based treatment would be impossibly expensive without an economical delivery method.”
He continued: “Despite these challenges, the lack of side-effects and brain protecting properties of xenon make it uniquely attractive as a potential treatment to apply alongside cooling in these babies. We are very grateful to Sparks, the children’s medical research charity, for supporting us in making this happen.”
Following rigorous Medicines and Healthcare Regulatory Authority approvals and other regulatory challenges, the device is now authorised for clinical trials and will be used on a minimum of 12 babies over the coming months. Successful completion of this feasibility trial is the first required step before larger trials on the effectiveness of the treatment can be done in baby units on a larger scale.
Many of the parts for Dr Dingley’s machine are specially built for the purpose by companies within Wales while other items are sourced from as far away as St. Petersburg in Russia.
‘The engineering heritage within South Wales has meant that I have been spoiled for choice whenever I have needed anything unusual constructed,’ Dr Dingley said,
‘Many local companies and individuals have helped me over the years, particularly PDR in Cardiff and I&G Engineering near Swansea. I designed equipment suitable for adults several years ago, however the challenges of developing a new design that works reliably and safely in babies is much greater. I have had to apply all the experience I have gained since 2000 to achieve this."
Professor Thoresen and Dr Dingley’s previously successful research work into cooling and the increased survival chances offered by xenon have been funded through the children’s medical research charity Sparks, which has committed almost £800,000 to the team’s pioneering work. The charity has, over recent years, committed almost £1.5m to cooling research, including the ‘CoolCap’ now being widely used in the NHS. Professor Thoresen was also heavily involved in the pioneering ‘CoolCap’ work.
The charity’s president, England World Cup winning hero, Sir Geoff Hurst, MBE, recently visited the Bristol project and yesterday commented:
‘Congratulations to Professor Thoresen, Dr Dingley and the rest of their dedicated team on this fantastic success. Breakthroughs such as this world-first graphically underscore the important role a charity like Sparks plays in funding pioneering research that really does make a difference. To me, a result like this is even more important than scoring the winning goal in a world cup final. I’m delighted that baby Riley hasn’t just survived a life or death situation, but can now look forward to a healthy future. That makes every penny Sparks has committed to this research work so worthwhile.’
Ends
Further information
The Patient
Baby Riley Joyce was delivered at the Royal United Hospital, Bath in a critical condition and was transferred to St Michael’s Hospital in Bristol because he showed signs of brain injury.
Born by emergency Caesarean section in Bath at full term, Riley had no pulse and was not breathing. He was resuscitated and his pulse was restored but his breathing still needed to be supported by a machine.
He did not move normally and a brain wave machine (EEG) showed an abnormal pattern. At this stage, the doctors in Bath knew that Riley would have to be transferred to St Michael’s in Bristol for cooling.
On arrival at St Michael’s his parents were told there was still a 50:50 chance of permanent injury and disability and they were asked by Professor Thoresen if they would agree to Riley being the first baby ever to have inhaled xenon gas as an experimental treatment that might improve his chances of full recovery.
After James Tooley and Marianne Thoresen had stabilised Riley at 33. 5 degrees Celsius, John Dingley connected Riley’s breathing machine to the xenon delivery system for three hours. Riley was kept cool for 72 hours, then slowly re-warmed and was able to breathe without the machine on day five.
Marianne Thoresen said: “After seven days, Riley was alert, able to look at his mother’s face, hold up his head and begin to take milk.”
Baby Riley’s parents, Dave and Sarah Joyce, say:
“We are delighted that Riley is doing so well and we are extremely grateful that we were given this opportunity. Marianne was so passionate about the treatment and we truly believe that she had and still has the best interests of Riley in mind. It was traumatic to see our baby not breathing, but seeing the ambulance coming to collect Riley to take him to Bristol gave us hope that something could be done to help him. We would like to thank all the team at St Michael’s Hospital for everything they have done for us.”
ENDS
Media contacts
Swansea University
Sian Newman – ILS Communications Manager
01792 602362 or mobile 07717 651280 or at s.y.newman@swansea.ac.uk. Alternatively, contact Bethan Evans, Swansea University Press Office on +44 (0)1792 295050 or at b.w.evans@swansea.ac.uk.
University Hospitals Bristol NHS Foundation Trust
Laura Treasure, Press Officer
0117 928 3718
SPARKS
Paul Connew , Director of Communications
0207 340 0681 or mobile 07711984785