Research tackles preterm babies' brain bleeds

Brain bleeds affect around one in five babies born before 32 weeks and can lead to lifelong disabilities, including cerebral palsy, learning difficulties and cognitive impairment.

In New Zealand, about 173 babies are diagnosed with the condition each year.

Senior Research Fellow Dr Simerdeep Dhillon at Waipapa Taumata Rau, University of Auckland, is investigating new ways to reduce the damage that can follow a bleed and improve outcomes for some of the country's most vulnerable babies.

"There are currently no treatments that directly prevent the resulting brain injury following a brain bleed,” Dhillon says.

Her research suggests that injury develops more slowly than previously thought, creating an opportunity for doctors to intervene before lasting harm occurs.

"We were surprised to find that the injury developed more slowly than expected. The brain remained relatively stable for several days after a bleed, before inflammation increased and began causing damage. That could give doctors a valuable window to intervene and help prevent further injury."

The research focuses on what happens after bleeding occurs. As blood breaks down in the brain, it releases excess iron, which researchers believe fuels inflammation and contributes to ongoing damage. Dhillon is investigating whether deferoxamine, a drug already used to treat iron overload in patients, could help.

"Our early findings show that removing excess iron soon after a brain bleed can reduce inflammation and lower the amount of brain injury that develops later,” she says.

"We're encouraged by these results and want to see whether the treatment could help improve outcomes for premature babies."

One advantage, she says, is that deferoxamine is already approved for clinical use and is used in hospitals for other conditions.

"If future studies confirm it is safe and effective for babies with brain bleeds, that could help speed the pathway to clinical trials."

The Neurological Foundation has awarded Dhillon a Senior Research Fellowship worth $341,924 to support the work. Combined with a complementary project grant, the Foundation has provided nearly $470,000 in funding for the wider research programme.

Brain bleeds often have no obvious symptoms in the days after birth, making early diagnosis difficult, she says. Many babies are identified through routine ultrasound scans several days later, potentially missing the period when treatment may be most effective.

To help identify affected babies sooner, Dhillon is also investigating whether subtle changes in physiological signals could provide warning signs of injury.

The team is examining patterns in blood pressure, heart rate and brain activity to see whether they can indicate a brain bleed before it is detected on routine imaging.

"Earlier detection could allow clinicians to investigate vulnerable babies sooner, provide treatment during the period when it may be most effective, and better manage complications and support babies and their families."

The work builds on decades of neonatal research at the University.

Dhillon completed her PhD under the supervision of Professor Laura Bennett, Associate Professor Joanne Davidson and the late Professor Alistair Gunn, whose pioneering work helped develop therapeutic hypothermia, a cooling treatment now used around the world to protect babies affected by oxygen deprivation during birth.

The team received the Prime Minister's Prize for Scientific Research in recognition of research that has improved outcomes for newborns globally.

"I started working with the team after my master's degree and it didn't take long to realise this was the field I wanted to work in for the rest of my life," says Dhillon.

She credits the group's collaborative culture with encouraging early-career researchers to pursue new ideas that could make a real difference for babies and their families.

The three-year research programme also includes a second Neurological Foundation-funded project exploring whether growth factors could help repair the brain once inflammation has been brought under control.

While the work is still preclinical, Dhillon says early results are encouraging.

"Even a small improvement would make a huge difference. If our work helps detect brain injury earlier or leads to better treatments, it could make life better for premature babies and their families.”