Meet the doctor putting Norwich at the cutting-edge of neonatal research
PUBLISHED: 17:07 12 September 2019 | UPDATED: 17:22 12 September 2019
Neonatal consultant Professor Paul Clarke is first to admit he’s ‘obsessed’ with giving premature babies a better chance at life. Stevie Smith visits Norfolk and Norwich University Hospital’s neonatal intensive care unit at Norwich Research Park to see the incredible work he’s doing.
Each month we meet one of the real-life heroes working at Norwich Research Park to learn how their work is progressing global research - and changing lives.
What made you want to specialise in neonatal medicine?
I still remember my first time entering a neonatal intensive care unit (NICU), it was daunting and like being in a different world, seeing tiny, fragile babies connected to lots of specialist equipment. It's kept me aware of the anxieties facing parents.
While training, I liked working with babies the most - to be able to help them when seeing how vulnerable they were, and to get them well enough to go home.
When I was first training, it was unusual for 24-week gestation babies to survive. Now, surviving at 23 weeks is not uncommon, and last year we had a 22-week gestation baby survive to go home; the first one I've ever seen in my career. He's a year old now and doing well.
Much of your work is dedicated to research that changes practice and, in turn, lives - why is that important to you?
The big advances in neonatal survival and better outcomes for survivors have essentially come about thanks to decades of careful research.
We want to be at the cutting edge, and units doing research are able to embrace the best treatments sooner and achieve the best outcomes for the babies they care for.
One example was our unit's participation in the Total Body Hypothermia (TOBY) trial, which tested whole body cooling to protect the brain in babies starved of oxygen around the time of birth.
If a baby is born with asphyxia, this oxygen starvation means they're born in a very poor condition, often causing cerebral palsy or sometimes death. Previously there wasn't a treatment to offer them. The study showed that if we cool babies for three days by just a few degrees below normal body temperature, it protects the newborn brain and reduces the risk of cerebral palsy.
Cooling is now standard care across the NHS, but we were able to offer it two years before it became routine practice, because we still had the trial equipment and our Trust permitted us to keep using it after the trial. So, we are early adopters of new treatments that research has shown to work. We probably prevented about four or five babies from getting cerebral palsy during that time.
What's some of the life-changing work you're doing right now?
Infection in babies is one of the biggest killers. Premature babies need special catheters to be inserted to deliver concentrated feed solutions. Because these catheters may sit in the veins for days or weeks, they carry a risk of infection. So, it's really important we put them in cleanly.
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Right now, we're running a study funded by the National Institute for Health Research (NIHR). It's comparing two different skin antiseptics to understand which is better and safer for disinfecting the skin of babies. We hope our trial will produce evidence for the wider NHS to help us know which antiseptic to use in pre-term babies to help prevent infection.
Doing research helps us to be a 'leading' rather than a 'following' NICU. I like to think that with our research, and the care we deliver, we are among the leading neonatal units in the UK.
Last year, we surveyed how many tertiary-level neonatal units routinely give probiotics to premature babies, and only 10 out of 58 did. Yet we've been doing it for almost seven years, because the research evidence suggested that giving probiotics to babies will protect them against a nasty life-threatening gut condition called necrotising enterocolitis.
We're about to publish a paper on this - showing that the rate of this gut condition has halved in our NICU since we started using probiotics.
What's been the proudest moment in your career so far?
My vitamin K thesis research, because it was the first randomised trial of vitamin K in pre-term babies and helped tailor the dosage we give them now.
Following on from that research, we've been doing a further study looking at whether pre-term babies should be given vitamin K supplements on discharge, in addition to the routinely-provided vitamins A, B, C and D.
How do you spend your time when you're not working?
I have a smallholding; I keep goats, sheep and hens, so that keeps me busy. It's the type of thing you can keep in your back garden living in Norfolk!
It's interesting to see the analogy between newborn lambs and newborn babies. Anyone working with lambs has it drummed into them about the importance of the ewe's colostrum - that's the first protein-rich substance the breast produces after birth, full of antibodies and nutrients.
It's crucial that lambs get this when they're born, and research has shown it's exactly the same 'liquid gold' for premature babies. There's been a real push for very premature babies to receive colostrum, even from within a few hours of birth, so we're really big on trying to support mothers to breastfeed.
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