Bangalore Medical College and Research Institute (BMCRI) is part of the largest study in the world on asphyxia-related brain injury and resultant epilepsy, called, the Prevention of Epilepsy by Reducing Neonatal Encephalopathy (PREVENT).
It is one of the three colleges in India that will undertake a study on 80,000 pregnant women and their babies (if born with brain injury), 20,000 of whom will be enrolled at BMCRI.
The study that costs Rs 30 crore, is a collaborative effort being led by Imperial College, London, in association with BMCRI. Childbirth brain injury is one of the leading causes of epilepsy in India. Asphyxia is a condition where the brain does not get the required amount of oxygen.
This results in a perinatal brain injury. As a consequence, babies suffer from epilepsy generally at 18 months of age. The aim of the study is to examine if involving birth companions among other interventions called ‘care bundle’ will reduce it.
Care bundle will have four key interventions. First, birth companion providing constant 1:1 care during labour and the time immediately before and after birth. Second, foetal surveillance during active labour by a nurse or midwife using a graphic display Doppler.
Third, labour management by an electronic partogram (a partogram is a composite graphical record of key data — maternal and foetal — during labour entered against time on a single sheet of paper. Relevant measurements might include statistics such as cervical dilation, foetal heart rate, duration of labour and vital signs) with an ‘alert’ and ‘nag’ feature based on the current World Health Organisation (WHO) guidelines.
Fourth, brain-oriented early newborn care with resuscitation where indicated. The study will be done for three-and-a-half years. The first year would involve enrolling mothers and data collection on key parameters without any interventions. The second year would involve interventions using the care bundle.
“Out of 20,000 pregnant women, 5% of babies may be born with brain injury caused by asphyxia. Asphyxia can be caused because of various factors including pre-existing conditions of the mother. We will monitor those 2,000 babies for 18 months after birth taking the duration of the study to 42 months,” said Dr Savitha C, HoD, Obstetrics and Gynaecology (OBG).
The OBG and Paediatrics departments at Vani Vilas Hospital attached to BMCRI will work in unison for the study. Dr Sahana Devadas, professor of Paediatrics, BMCRI, said, “All full term newborn infants admitted to the neonatal unit with perinatal brain injury will have video electroencephalography and MRI, and will be followed up until 18 months of age.”