A baby boy born at Saint Mary’s Wythenshawe, part of Manchester University NHS Foundation Trust (MFT), is the first to be part of research in Manchester that could help the recovery of pre-term babies (born two to six weeks before their due date) with serious breathing difficulties.
Babies born even a few weeks early may not be fully developed and often have breathing complications, which can be severe. Some babies need to go onto a ventilator soon after birth; and others do not, but still need support with their breathing.
The National Institute for Health and Care Research (NIHR) funded the “SurfON (Surfactant Or Not)” study, coordinated by the National Perinatal Epidemiology Unit Clinical Trials Unit (NPEU CTU) at the University of Oxford. The research trial is being delivered within Saint Mary’s Managed Clinical Service, part of MFT, as well as other sites across the UK.
Anney Chart 36, a tax manager and husband Chris, 37 who runs a small media company making videos and animations for businesses, live in Altrincham. Their first child, Ronnie was born two weeks early by Caesarean section (C-section) after Anney experienced dangerously high blood pressure. Chris recalled that the midwife first noticed an issue with Ronnie’s breathing soon after he was born.
Chris said: “His chest was moving strangely, and he was making a guttural sound. They tested his blood oxygen levels, which seemed to be decreasing and after further tests, he was taken to the high dependency ward.”
In the early hours of the next morning Chris was advised by the doctor that they suspected fluid on Ronnie’s lungs, which was causing him to struggle with his breathing, and meant there wasn’t enough oxygen in his blood.
Chris continued: “When I spoke to the lead doctor from the high dependency ward and we were asked about taking part in the study we were cautious at first, but once we knew that this was something that had been given before to premature babies that need it, we immediately agreed to take part.”
The lungs of healthy full-term babies produce a substance made up of proteins and fats (surfactant) that helps to keep the tiny air sacs in the lungs open, making it easier for them to breathe.
Dr Asim Ahmed, Consultant Paediatrician and Neonatologist at Saint Mary’s Wythenshawe, is leading the study at MFT.
He said: “Babies born early often do not make enough natural surfactant, or their surfactant does not work properly. As a result, babies may have difficulty expanding their lungs to take in oxygen. We can give a natural, animal-derived surfactant medication. We do this routinely soon after birth in many babies born more than 10 weeks early, to help their breathing.
“At the moment, there has been no research studies into the timing of giving surfactant in babies born closer to term (born two to six weeks before their due date) with breathing problems. Through the SurfON study we aim to learn if it is better to give surfactant early, when a baby first starts to have problems or if it is better to wait to see if they improve without it.”
This is a randomised controlled trial where the babies are randomly allocated into one of two groups decided by a computer program.
Babies in one group receive a single dose of surfactant when they first start to need help breathing. In the other group, the doctor will see if their breathing improves with non-invasive breathing support alone (using machines that give oxygen through soft, short tubes in the nose or small masks over the nose). Regardless of which group the baby is in, they may still receive surfactant if the doctor feels it becomes necessary.
Ronnie was given the surfactant which had a positive effect on his breathing. Two days later he was taken out of the high dependency unit and reunited with Anney and Chris.
Chris continued: “Ronnie is doing really well now and although he may have got better by himself, we’re glad we were able to take part in the study. Those first few hours of witnessing his breathing struggles was such a difficult time. I think a study like this is great because it could help doctors to learn if using this treatment earlier could ensure a baby isn’t in distress for an unnecessarily prolonged time, and that has to be better for everyone.”
The SurfON trial (IRAS ID: 269023) is sponsored by the University of Leicester. Further information about the study is available at nicuresearchteam@mft.nhs.uk, via the NPEU CTU team at surfon@npeu.ox.ac.uk, or the study sponsor at rgosponsor@leicester.ac.uk.