Liggins Institute


The CHYLD study

“Children with Hypoglycaemia and their Later Development” is a large multi-disciplinary cohort study following the development of young children who were identified as being at risk of developing neonatal hypoglycaemia.

Overview


Dr Deborah Harris, PhD and Nurse Practitioner at Waikato Hospital oversees a newborn baby in an incubator.
Dr Deborah Harris, PhD and Nurse Practitioner at Waikato Hospital; Lead Investigator for the BABIES and Sugar Babies studies

Low blood glucose concentration (hypoglycaemia) is a common problem in newborn babies. It is thought to be the single most preventable cause of brain damage in newborns.

We do not currently know which babies will suffer brain damage, or what blood glucose concentrations will trigger this, but the duration, severity and frequency of hypoglycaemia may all be important.

The purpose of our study is to follow up a group of children who were identified as being at risk of neonatal hypoglycaemia (babies of diabetic mothers, preterm, small or large), and for whom neonatal blood glucose concentrations are known. We intend to compare this neonatal data with mental and physical development, memory, vision and general health information gained at 2 years, and then again at 4.5 years, to understand how neonatal hypoglycaemia  relates to later development.

This research will provide critical information about how newborn babies should be monitored and treated in order to prevent brain damage and its long-term consequences, while minimising unnecessary interventions.

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Babies and blood sugar's influence on EEG Study.

Background - the BABIES and Sugar Babies studies


The 616 children in our cohort were initially recruited at Waikato Hospital, Hamilton, to either the BABIES or Sugar Babies studies. All were identified as being at risk of, or requiring treatment for, neonatal hypoglycaemia.

  • Babies identified as being at risk of hypoglycaemia included:
  • Small babies (birth weight <10th percentile or <2500 g)
  • Large babies (birth weight > 90th percentile or >4500 g)
  • Babies of mothers with diabetes
  • Babies who were stressed i.e. those suffering from sepsis, haemolytic disease of the newborn, respiratory distress, congenital heart disease
  • Babies not feeding well

In addition, the 102 children recruited for the BABIES study met the following inclusion criteria:

  • ≥ 32 weeks gestation
  • Admitted to the Neonatal Intensive Care Unit

The 514 children recruited for the Sugar Babies study met the following inclusion criteria:

  • ≥ 35 weeks gestation
  • Not yet treated for hypoglycaemia

The majority of babies who participated in these studies had their blood glucose concentrations continuously monitored in the first few days after their birth.

Read more about the Sugar Babies and BABIES studies
 

 

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Graphic of a smiling boy and girl holding hands.

CHYLD


Children with Hypoglycaemia and their Later Development

All children who participated in the BABIES and Sugar Babies studies are eligible to participate in the CHYLD study.

 

CHYLD Steering Group

 

 

 

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CHYLD 2 year study


Overview

 

404 children were followed up at 2 years, between June 2010 and January 2013 as part of our CHYLD 2 year Study. Children were assessed at 24 months corrected age ± 4 weeks.

Our assessment included:

  • Developmental assessment (cognition, intelligence, language, executive function and motor function)
  • Vision assessment (visual acuity, ocular health, motion coherence)
  • Paediatric assessment (growth, overall health)
  • Parental report (parental questionnaires – family demographics, child behaviour, social and emotional skills)
     

This data is currently being analysed.

 

CHYLD 2 year Team

CHYLD 2 year Assessment Team

  • Coila Bevan – Senior Research Nurse and Assessment Coordinator
  • Jessica Brosnahan – Study Coordinator
  • Dr Judith Ansell – Psychologist
  • Jenny Rogers – Maori Outreach Research Nurse and Developmental Assessor
  • Heather Stewart – Developmental Assessor
  • Christina McQuoid – Psychologist
  • Dr Kelly Jones – Psychologist
  • Sapphire Martin – Research Nurse
  • Dr Anna Timmings – BScHonours Student (Completed)
  • Dr Phil Weston – Paediatrician
  • Dr Arun Nair – Paediatrician
  • Dr Claire West – Paediatrician
  • Dr Chris McKinlay – Paediatrician
  • Dr Max Berry – Paediatrician
  • Dr Ailsa Tuck - Paediatrician
  • Dr Sandy Yu – Optometrist
  • Dr Nicola Antice – Optometrist
  • Associate Professor Rob Jacobs – Optometrist
  • Jo Arthur – Optometrist
  • Susanne Bruder – Optometrist
  • Gill Matheson – Optometrist


CHYLD 2 year Data Management Team

  • Dr Greg Gamble - Biostatistician
  • Janine Paynter- Data Manager
  • Anna Gsell- Data Manager
  • Grace McKnight- Data Entry/Research Assistant
  • Rebecca Young – Data Entry/Research Assistant
     

CHYLD 4.5 year study


Overview

 

We are currently inviting, recruiting, and assessing children for our CHYLD 4.5 year Study, which began in September 2011 and is due for completion in June 2015.
Children are being assessed at 54 months corrected age, ± 2 months.

Our assessment includes

  • Developmental assessment (cognition, intelligence, memory and executive function, auditory processing)
  • Vision assessment (vision and visual processing)
  • Paediatric assessment (growth, general health and neurological function)
  • Fine and Gross motor skill assessment
  • Parental report (parental questionnaires – family demographics, child behaviour, social and emotional skills)

 

CHYLD 4.5 year Team

CHYLD 4.5 year Assessment Team

  • Kelly Fredell
    Study Coordinator
  • Jenny Rogers
    Maori Outreach Research Nurse, Developmental Assessor
  • Heather Stewart
    Research Nurse, Developmental Assessor
  • Sapphire Martin
    Research Nurse
  • Christina McQuoid
    Psychologist
  • Neil Micklewood
    Psychologist
  • Arijit Chakraborty
    Vision Assessor, PhD Student
  • Nabin Paudel
    Vision Assessor, PhD Student
  • Dr. Nataliia Burakevych
    Paediatric Assessor, PhD Student
  • Ryan San Diego
    Developmental Assessor, PhD Student


Many Paediatricians also contribute to the assessments, including: Dr Phil Weston, Dr Arun Nair, Dr Claire West, Dr Alexandra Wallace, Dr David Graham, Dr Anne Jaquiery, Dr Jeremy Armishaw, Dr Nicola Webster and Dr Nicola Austin.


CHYLD 4.5 year Data Management Team

  • Dr Greg Gamble
    Biostatistician
  • Dr Yannan Jiang
    Statistician
  • Safayet Hussain
    Programmer/Database Developer
  • Karen Frost
    Database Manager
  • Dr Chris McKinlay
    Paediatrician/ Clinical Research Associate
  • Grace McKnight
    Data Entry/Research Assistant
  • Raquel Olmedo Rodrigues
    Data Entry/Research Assistant 
  • Jess Wilson
    Clinical Research Associate

CHYLD Support Team

  • Ellen Campbell
    Clinical Research Project Manager
  • Kate Sommers
    PA to Dist. Prof. Jane Harding
  • Coila Bevan
    Senior Research Nurse
  • Dr Matt Signal
    Bioengineer
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Read more about CHYLD


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Our students


Dr Judith Ansell

CHYLD 2 year, PhD completed

Judith is an educational psychologist with a special interest in the interplay between cognitive and behavioural development, especially in the area of executive function. Judith’s PhD project is titled Children with Hypoglycaemia and their Later Development (CHYLD Study) and is a follow-up study at 2 years of age of babies born at risk of neonatal hypoglycaemia. She is supported by a University of Auckland Doctoral Scholarship.

 

Dr Sandy Yu

CHYLD 2 year, PhD completed

Sandy is an optometrist with a special interest in paediatric optometry. Sandy’s PhD project is titled The effect of neonatal hypoglycaemia on visual function and global motion perception/detection at the age of two years. She is supported by a University of Auckland Doctoral Scholarship and has been awarded the HC Russell Scholarship by the New Zealand Association of Optometrists.

 

Dr Matt Signal

PhD completed

Matt is a Biomedical Engineering student with a special interest in the glucose-insulin regulatory system. Matt’s PhD project was titled Continuous Glucose Monitoring and Tight Glycaemic Control in Critical Care Patients. He was supported by a Department of Mechanical Engineering (University of Canterbury) Doctoral Scholarship and the Health Research Council of New Zealand.

 

Arijit Chakraborty

CHYLD 4.5 year, PhD Student

Arijit is an optometrist with a special interest in visual development and visual processing, and how these relate to other neurodevelopmental aspects. Arijit’s PhD project is titled The Effect of Neonatal Hypoglycemia and Prenatal Exposure to Recreational Drugs on Visual Development at 54 months. He is supported by a University of Auckland Doctoral Scholarship.

Nabin Paudel

CHYLD 2 year and 4.5 year, PhD Student

Nabin is an optometrist with a special interest in paediatric vision development, particularly in the areas of visual acuity and global motion perception. Nabin’s PhD project is titled The Effects of Neonatal Hypoglycaemia on Visual Development. He is supported by an Auckland Medical Research Foundation Doctoral Scholarship.

 

Dr Nataliia Burakevych

CHYLD 4.5 year, PhD Student

Nataliia is doctor with a special interest in paediatric nutrition and its effect on health in later life. Nataliia’s PhD project is titled Childhood Outcomes in Children at Risk of Neonatal Hypoglycaemia. She is supported by a Doctoral Scholarship from Gravida – National Centre for Growth and Development .

 

Ryan San Diego

CHYLD 4.5 year, PhD Student

Ryan is a registered psychologist with a special interest in psychological statistics, child health and development, consequences of neurotoxin, child psychopathology and developmental cognitive science. Ryan’s PhD project is titled Risk Factors and Resilience Mechanisms in Neurocognitive, Motor, Visual Perception and Behavioural Outcomes of Young Children with Neonatal Hypoglycaemia: A Comparative-Multiphase-Multilevel Study. He is supported by a University of Auckland Doctoral Scholarship.

 

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Collaborators


This project involves collaboration between the Liggins Institute, the University of Auckland Department of Psychological Medicine, and Department of Optometry and Vision Sciences,and The University of Canterbury Department of Mechanical Engineering.

The CHYLD Study also has an International Advisory Board of senior research leaders:

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Research impact


This study will allow us to provide an evidence base to inform clinical practice by determining the relationship between the duration, frequency and severity of low glucose concentrations in different groups of at-risk newborn babies and their later developmental outcomes. This information will help guide clinical practice in the short term, while also providing the evidence base upon which randomised trials of appropriate interventions can be designed.

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Media coverage


CHYLD Principal Investigator Distinguished Professor Jane Harding, Maori Outreach Research Nurse, Jenny Rogers and Developmental Assessor Heather Stewart feature in the University of Auckland’s Auckland Now publication, show-casing CHYLD.

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Publications


Harris, D. L., Weston, P. J., & Harding, J. E. (2014). Mothers of babies enrolled in a randomized trial immediately after birth report a positive experience. Journal of Perinatology 10.1038/jp.2013.183
URL: http://hdl.handle.net/2292/21838

Yu, T. Y., Jacobs, R. J., Anstice, N. S., Paudel, N., Harding, J. E., Thompson, B., & CHYLD Study Team (2013). Global Motion Perception in 2-Year-Old Children: A method for psychophysical assessment and relationships with clinical measures of visual function. Investigative Ophthalmology and Visual Science, 54 (13), 8408-8419. DOI: 10.1167/iovs.13-13051
URL: http://hdl.handle.net/2292/21380

Harris, D. L., Weston, P. J., Harding, J. E., Signal, M., & Chase, J. G. (2013). Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): A randomised, double-blind, placebo-controlled trial. The Lancet, 382 (9910), 2077-208310.1016/S0140-6736(13)61645-1
URL: http://hdl.handle.net/2292/21368

Harris, D. L., Weston, P. J., & Harding, J. E. (2012). Incidence of neonatal hypoglycemia in babies identified as at risk. Journal of Pediatrics, 161 (5), 787-79110.1016/j.jpeds.2012.05.022
URL: http://hdl.handle.net/2292/19588

Signal, M., Le Compte, A., Harris, D. L., Weston, P. J., Harding, J. E., & Chase, J. G. (2012). Impact of retrospective calibration algorithms on hypoglycemia detection in newborn infants using continuous glucose monitoring. Diabetes Technology and Therapeutics, 14 (10), 883-89010.1089/dia.2012.0111
URL: http://hdl.handle.net/2292/19587

Signal, M., Le Compte, A., Chase, J. G., Harris, D. L., Harding, J. E., Weston, P. J., ... Yu, S. (2012). Using Stochastic modelling to identify unusual continuous glucose monitor measurements and behaviour, in newborn infants. BioMedical Engineering Online, 11.10.1186/1475-925X-11-45
URL: http://hdl.handle.net/2292/19585

Signal, M., Le Compte, A., Chase, J. G., Harris, D. L., Weston, P. J., & Harding, J. E. (2012). Impact of calibration algorithms on hypoglycaemia detection in newborn infants using continuous glucose monitors. IFAC Proceedings Volumes (IFAC-PapersOnline), 242-247 10.3182/20120829-3-HU-2029.00031

Signal, M., Le Compte, A., Chase, J.G., Harris, D.L., Weston, P.J., & Harding, J.E. (2012). Using a stochastic model to detect unusual continuous glucose monitor behavior in newborn infants. IFAC Proceedings Volumes (IFAC-PapersOnline), 248-253 10.3182/20120829-3-HU-2029.00032

Harris, D. L., Weston, P. J., Williams, C. E., Pleasants, A. B., Battin, M. R., Spooner, C. G., & Harding, J. E. (2011). Cot-side electroencephalography monitoring is not clinically useful in the detection of mild neonatal hypoglycemia. Journal of Pediatrics, 159 (5), 755-760
URL: http://hdl.handle.net/2292/9071

West, C.R., Harding, J.E., Williams, C.E., Nolan, M., & Battin, M.R. (2011). Cotside electronencephalography for outcome prediction in preterm infants: Observational study. Archives of Disease in Childhood: Fetal and Neonatal Edition, 96 (2), F108-F113. 10.1136/adc.2009.180539

Harris, D. L., Battin, M. R., Weston, P. J., & Harding, J. E. (2010). Continuous glucose monitoring in newborn babies at risk of hypoglycemia. Journal of Pediatrics, 157 (2), 198-20210.1016/j.jpeds.2010.02.003
URL: http://hdl.handle.net/2292/6289


Harris, D. L., Weston, P. J., Battin, M. R., & Harding, J. E. (2009). A survey of the management of neonatal hypoglycaemia within the Australian and New Zealand Neonatal Network. J Paediatr Child Health. 10.1111/j.1440-1754.2009.01599.x
URL: http://hdl.handle.net/2292/6279
 

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Funding


We gratefully acknowledge funding from the following sources:

  • National Institutes of Health, USA
  • Health Research Council
  • Auckland Medical Research Council
  • University of Auckland Faculty Research Development Fund
  • Waikato Medical Research Foundation
  • Maurice and Phyllis Paykel Trust
  • Rebecca Roberts Scholarship
  • New Zealand Nurses Organisation
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Contact us


For further information, or to make an enquiry, please email us at CHYLD@auckland.ac.nz.

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