Cerebral Palsy Alliance grant success

Up to 92 per cent of preterm babies struggle to breathe at birth and require respiratory support to survive. While life-saving, this respiratory support injures their immature brains leading to life-long consequences including cerebral palsy. In addition, 40 to 70 per cent of preterm babies are exposed to infection and inflammation in the womb, and this further increases the requirement for respiratory support and increases the risk and severity of perinatal brain injury.

While research to date has focused on improving respiratory support techniques, a major issue has been overlooked. That is, understanding why these babies cannot breathe in the first place.

The brainstem is a life-sustaining brain region containing several ‘respiratory centres’ vital for breathing. These respiratory centres generate and modulate our respiratory rhythm, change breathing patterns based on oxygen and carbon dioxide levels; and control the muscles necessary for respiratory function and for maintaining an open airway. Despite the critical importance of the brainstem in controlling breathing, it has largely been ignored as a cause or contributor to breathing difficulties. This research project focuses on this critical aspect of breathing.

The team’s research has shown that inflammation in the womb stops fetal breathing. Importantly, when fetal breathing stops, this correlates with inflammation in the brainstem and particularly with the inflammatory molecule prostaglandin E2 (PGE₂). It is thought that inhibition of fetal breathing by PGE₂ may result in breathing difficulties at birth, and thus increase the requirement for respiratory support which is known to increase the risk of brain injury.

In a major breakthrough, the team’s research has shown that reducing inflammation and PGE₂ levels in the brain stem  using the anti-inflammatory drug ibuprofen restores fetal breathing.

Ultimately, the team aims to demonstrate that targeting PGE₂ during fetal life will reduce the need for respiratory support at birth and minimise brain injury in preterm babies.

Up to half of adults with cerebral palsy (CP) will develop thin bones (osteoporosis) and broken bones which can severely decrease mobility and quality of life. Concerningly, up to three quarters of adults with CP will lose their ability to mobilise and many will need assistive devices. Therefore, preserving bone health in adults with CP is key to maintaining independence, but there are no guidelines for doctors and caregivers.

The project aims to provide the first adult guidelines for osteoporosis in CP. There will be a specific focus on how best to transition care from child to adult services to ensure bone health is maintained. To develop these guidelines, what is already known about osteoporosis in adults with CP will be reviewed and summarised.

A team of experts will trial this information to develop recommendations on

• Which adults with CP should be screened for osteoporosis
• How to diagnose osteoporosis in adults with CP
• Management strategies for osteoporosis in CP.

A consensus between the experts will be obtained and then the recommendations will be open for public review. The team aim to have the guidelines published and disseminated within two years. The guidelines will include

• A practical summary and algorithm to inform clinical practice
• A review of published literature examining the evidence for diagnosing and treating osteoporosis in CP
• Practical tools and documents for clinicians using the pathway
• A lay description of the summary for consumers with CP and their caregivers.

The project will increase awareness among doctors, consumers with CP and caregivers so that bone health is examined as part of routine care.