Steps to progress with neonatal infections

The birth of a baby is an unforgettable moment for parents; nothing compares to meeting your tiny person for the first time. For most, it’s a beautiful experience, but for some it can be a difficult time - particularly if the baby is unwell.

The role of midwives cannot be understated. Fifty-three thousand midwives are employed in the UK, many part-time. They look after women and babies during pregnancy (almost half of mums-to-be see the same midwife each appointment), labour, and after birth.

Most babies (more than six in ten) are born in midwife-led units, run entirely by midwives and their support staff. For women who choose to have their baby in one of these units, there is a better chance of natural labour without medical intervention, less trauma to mother and baby and a shorter recovery time.

And of course, if something unexpected does happen, midwives are on hand to take immediate action. They are trained in the emergency care of babies and can spot illnesses as soon as a new-born shows signs of struggling.

What is neonatal infection?
Neonatal infections are infections picked up by a new-born baby. These can manifest very early on –within 24 – 48 hours of birth – and can be caused by a variety of different bacteria, viruses, or fungi.

Severe infections can develop into sepsis – a condition where infection reaches the blood stream and affects how other organs in the body work. This is an emergency, and babies with suspected sepsis are taken to a specialised neonatal intensive care unit (NICU) where they can be treated urgently.

Why can neonatal infection treatment cause problems?
New-born babies with sepsis are given antibiotics as soon as possible – ideally within one hour of the condition being suspected. Delay can result in the baby becoming even more unwell. In the early stages, the pathogen causing the infection is unknown, so a combination of antibiotics is prescribed to cover all common infections.

One of these is gentamicin – an antibiotic in the treatment of neonatal sepsis. It’s prescribed all over the UK in line with national guidance. However, gentamicin has a potentially devastating side effect when used in people carrying a particular gene variant in their DNA –  lifelong hearing loss.

Approximately 1 in 500 people have the variation in their DNA causing hearing loss on exposure to the antibiotic, and a single dose given to these individuals can cause lifelong impairment. Every year in the UK, approximately 180 babies lose their hearing after receiving gentamicin. While other antibiotics are available instead of gentamicin, these have a higher risk of generating resistant strains of infection and therefore are not preferred for routine use.

How can we solve the problem of unanticipated side-effects?
Knowing which babies are at risk of hearing loss on exposure to gentamicin provides an opportunity to customise a baby’s antibiotic regime, avoiding this potential side effect. Genedrive have been working NHS clinicians and research staff to develop a bedside genetic test that allows nurses to quickly identify babies carrying the gene variant.

This new emergency screening test analyses a baby’s DNA to detect the key gene variant that makes them susceptible to hearing loss on treatment with gentamicin. A simple cheek swab sample is the source of the sample tested, which is a ten second, painless, non-invasive procedure for the baby.

The swab sample goes into a genetic testing machine located on the ward or unit (it doesn’t need to go to a laboratory for analysis), with the result available in 26 minutes. A positive result demonstrates the baby has the gene variant; a negative result means the NICU nurse is fine to proceed with the use of gentamicin.

Why is DNA screening so important?
Time is of the essence when a baby is unwell with sepsis, yet traditional lab tests can take days to deliver results. In the case of this gene variant, babies with the gene need to be identified within the ‘golden hour’ of the emergency window and given gentamicin with full confidence it is the best option, or an alternative if the baby has the gene variant.

Before development of the test, doctors had no way of knowing in an emergency setting whether a baby carried the gene. By using DNA screening technology, life-saving antibiotics are not delayed, and each baby is given the best possible treatment.

Is the test available everywhere?
The screening test is being implemented in the neonatal intensive care units of hospitals across the North West, with plans to extend further over time. The Company is working with thought leading hospitals to implement the test, while establishing funding through NHS England and the devolved healthcare systems. Medical regulatory bodies in the UK have already highlighted the importance of personalised medicine. Treatment is tailored to an individual person based on their genes. Genetic screening tests are part of introducing a more effective and personalised approach to administering medicine across the NHS.

Empowering front line healthcare staff
Hearing loss is known to have a profound impact on child development due to missed opportunities to learn words and sounds. It’s associated with delayed speech and language, additional challenges at school, lower self-esteem, and difficulty in social situations. For about 14,000 babies across the world every year, this could be avoided by simple screening tests.

Midwives play a crucial role in identifying babies with hearing problems. The new-born hearing test is carried out on babies within the first few weeks of life and picks up babies whose ears don’t respond to gentle clicking sounds played through a soft earpiece. This new genetic screening test empowers nurses further.

David Budd with gene drive

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