Dr. Martín Iriondo
“The goal of our research is to reduce the morbidity of newborn babies with problems and improve their long-term development.”
It can be rightly said that the driving force behind the research carried out by the Neonatology Department at the Sant Joan de Déu Barcelona Children's Hospital was Dr Xavier Krauel, who laid the first stone of what is now the Neonatology Research Group at the Sant Joan de Déu Research Institute (IRSJD), led by Dr Martín Iriondo, the current head of the department.
This research team focusses mainly on two lines: research into neonatal nutrition and metabolism, a line led by Dr Isabel Iglesias; and care and resuscitation of critical newborns, led by Dr Martí Iriondo. Furthermore, this team actively collaborates with other IRSJD research teams.
Before we start the interview, could you tell us how a premature baby differs from a critical newborn?
We define a premature baby as one born before 37 weeks of pregnancy. Our group focusses part of its efforts on very premature babies, those born at less than 32 weeks of pregnancy. In contrast, a critical newborn is one in a pathological situation that requires high-intensity care at the beginning of life. This includes premature babies born before 32 weeks of pregnancy (often with a birth weight between 500 and 1500 g), and other newborns with a severe malformation pathology such as congenital diaphragmatic hernia or a congenital heart disease, among others.
What research activities are you currently carrying out with these children?
In the line of critical newborns care and resuscitation we are collaborating to evaluate the optimal oxygen concentration needed to start resuscitation in premature babies born before 30 weeks of pregnancy. Ten years ago the oxygen values used at the start of resuscitation were very high and this was found to cause oxidative stress and encourage the appearance of pathologies such as retinopathy of prematurity. We have participated in two multi-centre studies, one national (REOX) and one international (PRESOX), to evaluate the optimal initial oxygen concentration in the delivery room. These studies have resulted in recommendations for the use of low oxygen concentrations at the start of resuscitation of premature babies.
As regards metabolism and nutrition, the goals of this line focus on how to safely and effectively ensure that the growth of premature babies is as close as possible to the one they would have experienced in the mother's womb, improving their development and minimising complications in their adult life, as well as understanding the implications of glucose regulation in the baby.
You also work with other research teams at the IRSJD and Sant Joan de Déu. What can you tell us about it?
In the case of the critical newborn, we cooperate on some lines of research followed by the foetal medicine team led by Dr Eduard Gratacós (director of BCNatal). We work with his team to better understand the mechanisms that reduce the survival rate of newborns affected by congenital diaphragmatic hernia (CDH). This is an embryonic defect of the diaphragm, which causes part of the organs of the digestive tract to migrate into the chest, resulting in poor development of the lungs. It is a condition with high mortality and morbidity rates due to pulmonary hypoplasia and, in particular, alterations in the development of the blood vessels. We are studying the expression of angiogenic growth factors in the amniotic fluid of foetuses affected by CDH in relation to the degree of pulmonary hypertension developed after birth and its subsequent evolution (Jordi Clotet).
Some professionals from the Neonatology Department work with other research groups at the Sant Joan de Déu Research Institute, specifically with the Neonatal Brain group led by Dr Alfredo García-Álix, studying brain maturation after preterm birth (Thais Agut and Núria Carreras) and neonatal infections with an impact on the developing brain (Ana Alarcón), and with Dr Joan Sánchez de Toledo's Paediatric Cardiology group, assessing the predictive capacity of integrated brain monitoring of neurodevelopment alterations during neonatal cardiac surgery (Marta Camprubí and Débora Cañizo).
The Nutrition and Metabolism grup works with members of the group specialised in paediatric metabolic diseases (Marta Ramón and Carles Lerin).
Internationally, the Neonatology research group is collaborating with Arjan Te Pas (Leiden University Medical Center) and Marta Thió (The Royal Women's Hospital Melbourne, Australia), who are participating in a joint study to assess lung function in the resuscitation of patients affected by CDH (Cristina Carrasco and Jordi Clotet).
For the study of glucose monitoring and regulation in premature babies we are collaborating with an international group coordinated from Cambridge (Kathryn Beardsall), and we are participating (Montse Izquierdo) in a global project on the growth of premature babies, Intergrowth-21st (Prof. J. Villar).
How does your research impact the quality of life of these newborn babies?
On the one hand, as I mentioned before, we are studying how to optimise the resuscitation of premature babies so as to minimise its consequences, and, on the other hand, Dr Isabel Iglesias' group is studying how to optimise the nutrition of these babies, how to improve body weight gain and how to identify strategies for reducing complications such as necrotising enterocolitis and developmental disorders, among others. To make this possible, we are working on the individualised characterisation of growth trajectories, taking into account factors such as body composition and the study of the nutritional content and bioactive factors in the mothers' milk.
Nutrition in premature and low birth weight babies is very important and can have a long-term impact. In a study by Dr Marta Camprubí in a rat model, we found that low birth weight babies displayed learning difficulties and memory problems and even had different synapses in the hippocampus.
What challenges have you planned for the research group in the future?
We have developed a mortality calculator for Spanish premature babies based on data from the SEN-1.500 Network, which contains all the data from 60 Spanish hospitals on infants under 1,500 g or born with less than 30 weeks pregnancy. We have used this data to define three predictive models of neonatal death, one for babies before birth, one for the first 24 hours of life and the other one for long-stay babies. Right now we are in the evaluation phase of a prospective study. We hope to be able to make it available to health centres in the future.
We want to carry out a deeper study of the protective biological mechanisms present in breast milk, some of which could be incorporated as supplements in the future when breastfeeding by the mother herself is not possible. We currently count on 2017 FIS funding for this research.