4-year PhD Studentship: Monitoring fetal wellbeing before birth using Electroencephalogram and Near Infrared Spectroscopy

In the UK, around 3.4/1000 newborn babies sustain brain injury, predominantly due to intrapartum hypoxia ischaemia.1 The Department of Health, in 2015, committed to significantly reducing such injuries.2 In the current clinical practice, fetal well-being before birth is monitored by assessing the fetal heart rate (FHR) and it’s temporal trend to uterine contractions using cardiotocography(CTG).3 The sensitivity and specificity of CTG to detect hypoxic fetuses is low resulting in unnecessary operative deliveries of uncompromised fetuses, missing hypoxic fetuses and increasing maternal morbidities. To improve identifying fetal hypoxia, fetal electrocardiogram assessed using fetal scalp electrodes applied on fetus scalp has been introduced, but this does not reduce neonatal brain injuries.4 Therefore, there is an urgent need to develop a robust multimodal fetal monitoring for detecting intrapartum fetal hypoxia.

Monitoring brain activity using amplitude integrated encephalogram (aEEG) and brain oxygenation using Near Infrared Spectroscopy (NIRS) in newborn babies after birth consistently identifies brain dysfunction and predicts future neurodisability.5 Our interdisciplinary research group demonstrated a proof of principle for monitoring human aEEG and heart rate by using a signal splitter and application of FSEs to the scalp of adult volunteers.6 We are working to integrate NIRS to this monitoring.

Aims and objectives

Hypothesis: A multimodal fetal monitoring technique comprising of aEEG, FHR and NIRS would identify a fetus affected by intrapartum hypoxia-ischaemia.

1. To obtain refined EEG data (after digital signal processing) using our Fetal Heart Rate and aEEG monitoring system (FEMS) on fetuses before delivery.
2. Develop a new near-infrared spectroscopy sensor with associated signal processing elements that can be attached to the scalp and obtain reliable signals from fetuses before delivery.
3. To examine the association between fetal EEG and NIRS data and neonatal outcomes.

Methodology

We are waiting for the ethics approval for an intrapartum fetal study that will employ our novel fetal monitoring technique to obtain the fetal heart rate and fetal brain activity signal before birth. Under the leadership of Professor N Dahnoun, the student will work on sensors and digital processing to achieve a consistent and accurate data acquisition, processing and recording. We will attempt to attach the existing commercially available NIRS sensor on the fetal head to obtain cerebral oxygenation data. However, the wet fetal scalp surface and movements induced by uterine contractions are likely to impact the adherence of the commercially available NIRS sensor on the fetal head.

The student will work on developing a custom NIRS sensor that is optimized for size and sensitivity

Due to the natural movement of the fetus, the student will also consider different electrode configurations to improve the signal-to-noise ratio and increase reliability.

Fetal and neonatal outcomes will include fetal and neonatal blood gas parameters, Apgar scores, admission to the neonatal unit, length of hospital stay and neonatal encephalopathy.

The student will gain skills in signal processing, developing near infrared spectroscopy sensors, and examining clinical data, data analysis, interpretation and academic writing.

How to apply for this project

This project will be based in Bristol Medical School - Translational Health Sciences in the Faculty of Health Sciences at the University of Bristol.

Please visit the Faculty of Health Sciences website for details of how to apply