Take 10 with... Barbara Cormack
Dr Barbara Cormack explains her research into nutrition for preterm babies and the joy of being able to apply the findings to clinical practice.
1. Describe your research topic to us in 10 words or less.
Does better early nutrition in preterm babies improve growth and neurodevelopment?
2. Now describe it in everyday terms!
It’s difficult to feed very preterm babies when they’re born - most need to have nutrition through a tube. This means that instead of a baby deciding what nutrition they need and the amount they want to have, for example by breastfeeding, we have to decide what to give them, but we don't know exactly what they need. My research is trying to find out exactly what nutrition we should be providing to give preterm babies the best opportunity to survive, to grow well and for their brain to develop well.
3. What are some of the day-to-day research activities you carry out?
The main thing I've been involved in is a multi-centre randomised controlled trial called ProVIDe, which is looking at whether giving the smallest preterm babies some extra protein improves their neurodevelopment. It involves writing grant applications, writing papers and meeting other researchers to talk about new projects - especially projects that fall out of the research that we've done to date. We've collected a lot of data for ProVIDe which included about 434 very small preterm babies. This study is more than twice the size of any previous study on this topic so now we're trying to make the very best possible use of all the data we have.
4. What do you enjoy most about your research?
I enjoy finding something new and interesting that nobody else has thought of, or a new and different way to do something, and presenting it to colleagues nationally and internationally. As a clinical researcher I can take the findings and directly apply them to improve nutrition for babies. Maybe that’s the most satisfying thing actually, being able to translate research findings into clinical practice very quickly.
5. Tell us something that has surprised or amused you in the course of your research.
I've always been really interested in protein and whether more protein would improve growth and development for preterm babies. However most of the studies that have been done have had great difficulty getting enough of a difference between the control and the intervention group because of concerns about the baby’s urea being too high. When I first started to do audits on preterm babies’ nutrition I noticed that there was a lot of fluid going into the babies via the UAC (umbilical arterial catheter), which is used to measure their blood pressure and take blood samples. When measurements are not being taken the line has to be kept open with saline solution, which is completely wasted fluid. I’d always wondered if it could instead be used to give them nutrition. Then one day at a Liggins Institute event I met a Swedish neonatologist who explained that in Sweden babies are given extra protein via the UAC, which really surprised me. Once I knew that, I knew we could do the ProVIDe study that way.
Some of the results we’ve found have also been surprising. We found that refeeding syndrome was associated with three times the rate of death before discharge from NICU. We also found associations with intra-ventricular hemorrhage and low blood phosphate. This needs more investigation because we don't know for sure whether one causes the other, but the point is these are all very important clinical discoveries.
6. How have you approached any challenges you’ve faced in your research?
The whole thing's a challenge really. I just sit down and think hard and try to find another way to do it. And that's really what I was talking about with the UAC. I could see what was going wrong with these other studies and found another way to deliver the protein that would get round problem. I'm quite persistent, so usually I find a way.
7. What questions have emerged as a result?
We found that having a very low blood phosphate is associated with really important clinical outcomes like death and brain injury. However we don't know whether babies have a low phosphate because brain injury occurred, or whether the brain injury occurred because of the low phosphate. So we’re doing more research to see if giving the babies some more phosphate decreases the mortality rate and risk of brain injury.
8. What impact is your research having or what impact do you hope it will have?
It has raised questions about refeeding syndrome – (potentially fatal shifts in fluids and electrolytes that can occur in malnourished people who are fed artificially) - which wasn’t thought to happen in preterm babies. A couple of people began raising this question in 2013, the year before we started recruiting to the ProVIDe trial, so we included some blood tests in the trial to look at refeeding syndrome or whether it even existed. The impact of this research is that it's made us question our current practice of giving babies very low electrolyte (calcium and phosphate) intakes in the first two days after birth, which is something that's been done worldwide for over a decade. In New Zealand several of the neonatal units have already stopped doing this, and we are running an observational study to monitor the outcome.
Since we did the ProVIDe study, some international recommendations have come out about nutrition in preterm babies that say we should be giving them more electrolytes in the first two days. It’s based on very little evidence, but it is an international consensus recommendation, so we're making an improvement that meets the current recommendation and then observing whether it changes the outcomes.
9. If you collaborate across the University, or outside the University, who do you work with and how does it benefit your research?
I work with neonatologists and dietitians at the Liggins Institute, researchers at other New Zealand universities, and with dietitians throughout New Zealand and Australia. I also collaborate with neonatologists and dietitians in Canada, the US and the UK. They all have different views, different ideas and slightly different practices that might have possibilities for how you do something or how you change something. These relationships are important because when you come up with something new, your collaborators take the information seriously because they know you’ve done the research well and are therefore more likely to implement the findings.
10. What one piece of advice would you give your younger, less experienced research self?
That's easy. I wish I'd done a PhD sooner. By the time I came back to university, I had two sons who were also university at the same time, which makes it a little bit harder!