Newsletter_ May 2022 Vol 9

MAY2022 | VOL.9 PREVENT NEWSLETTER Quarterly Newsletter of the PREVENT Study IN THIS ISSUE.. OUR ACTIVITIES SPOTLIGHT ECR INITIATIVES NEWS TO CELEBRATE THE Prevention of Epilepsy by reducing Neonatal Encephalopathy (PREVENT) TRANSFORMATIONAL is the world's largest study on newborns with brain injuries. In collaboration with experts and institutions from around the world, we aim to prevent PATH epilepsy caused by neonatal encephalopathy through the implementation of a pragmatic intrapartum care bundle in India. NEXT QUARTER To learn more, visit us at our website Follow us on Twitter

May 2022, Vol. 9 Abstract The PREVENT study aims to prevent epilepsy caused by neonatal encephalopathy in India by implementation of a pragmatic intrapartum care bundle. The first phase of our study has been completed and we have now moved on to the second phase on 1st of March 2022. The site investigators met face to face at Bengaluru in February 2022 for discussing the potential site specific challenges with respect to the implementation of care bundle and came up with the optimum approach. As the second phase began, we organized a formal dissemination event and the care bundle is now actively implemented across all the sites. So far, we have enrolled more than 45,000 mothers for the study. We also diligently continue with our academic sessions for team such as multi country journal clubs, weekly EEG training sessions and also the PhD programmes. PREVENT team at the Study Investigators Meeting held at Bengaluru in February 2022 2 PREVENT Quarterly Newsletter

May 2022, Vol. 9 \"We Care, We PREVENT\" The site investigators along with the clinical team & PREVENT members moved ahead with determination in order to begin the implementation of our care bundle on March 1st, 2022 following the various brainstorming sessions and discussions with our collaborators and principal investigators. Hubballi Team Calicut Team The PREVENT team gathered together at each respective site and formally launched the second phase. Our slogan was \"We Care, We PREVENT\" and clinicians, teaching faculties, DEAN, Medical superintendents and other allied staffs came together to show their support for the PREVENT study. Bengaluru Team 3 PREVENT Quarterly Newsletter

May 2022, Vol. 9 Our Activities We conduct monthly journal clubs presented by our clinical research fellows and PhD scholars to update and discuss the advancements in their field of practice. Being moderated by experts from the field, the discussions and debates around the novel literature offers a challenging and useful learning experience to our early stage researchers. Another initiative which focus on capacity building of our staffs is the weekly training sessions led by pioneering clinical neurophysiology experts on specific topics related to neonatal electroencephalography and epilepsy. The sessions provide insights for detecting the epileptic seizures in high risk neonates and for ruling out the neurological diagnosis and prognosis in severely ill newborns. 4 PREVENT Quarterly Newsletter

May 2022, Vol. 9 Our Activities In partnership with the midwifery researchers from LSTM, we also trained our dignity game champions on Qualitative Data Collection Methods and had an introductory session on Community Engagement Activities in Clinical research for the Public and Patients Involvement (PPI) team members. Meeting and interacting with new persons can open up key opportunities and boost up early academic career. One of our doctoral fellows attended informal interaction session with other Phd students from different lower and middle income countries of Asia and Africa, in order to share connections regarding their research interests in maternal and child health. 5 PREVENT Quarterly Newsletter

May 2022, Vol. 9 Spotlight The annual Paediatric Academic Societies meeting took place in Denver, USA from 21st – 26th April 2022. Even though this is an event hosted by colleagues in the United States, there were many exchange of learning between global members of the neonatal community. A group of fellows from the Centre of Perinatal Neuroscience (CPN) had the opportunity to attend and more proudly, a few successfully earned a place in oral and poster presentations. Dr Vidya, Neonatal Neurology Research Fellow of PREVENT delivering an oral presentation at PAS 2022 6 PREVENT Quarterly Newsletter

May 2022, Vol. 9 Spotlight Our team contribution for PAS Electrographic Response to Levetiracetam as Second Line Antiseizure Quantitative magnetic resonance assessment of brain injury after Medication In Neonates – A Prospective Multicentric Study neonatal encephalopathy: A nested study within the Hypothermia for Dr Vidya Ujjanappa and team Encephalopathy in low- and middle-income countries (HELIX) trial Dr Paolo Montaldo and team This study looked at the effect of giving levetiracetam to neonates with seizures who did not respond to phenobarbitone. The reason for doing this is This study set out to explore whether MR biomarkers can accurately predict although levetiracetam is widely used as a second line neonatal anti-seizure adverse neurodevelopmental outcome after HIE in LMICs. It is acknowledged medication, its efficacy with continuous EEG monitoring is not well established. that quantitative magnetic resonance (MR) biomarkers can help speed up Levetiracetam effect was assessed in group that had continuous EEG and neuroprotective drug development in high-income countries. However, its utility group that did not. The results showed that majority of babies did not respond in low and middle-income countries (LMIC) is yet unknown, even though to levetiracetam based on EEG monitoring. In the group without EEG, it LMICs bear the bigger burden of hypoxic ischaemic encephalopathy. The appeared that the response was better. However, this is falsely reassuring authors found that the because the lack of EEG monitoring means the effect of treatment is quantitative MR biomarkers at 2 weeks accurately predict death or moderate or overestimated (ie. It probably was not seizure in the first place!) severe disability at 18 to 22 months after moderate or severe neonatal encephalopathy in LMIC and are not affected by cooling therapy. What this means for LMIC: This was a very important study because the controversies in neonatal seizure treatment exists worldwide, not just in LMICs. What this means for LMIC: We can be confident when doing clinical trials of There were several presentations in PAS discussing the evidence of seizure neuroprotective drugs or treatment in LMIC that we impact can be assessed treatment and role of EEG in seizure diagnosis. It highlights the importance of using the 2 weeks scan, rather than traditionally having to wait until the babies having continuous EEG monitoring in seizure diagnosis, a practice with which reach 2 years old. Hopefully this means quicker translation from research to PREVENT is leading the way at a global level! clinical use! Development and validation of a physical maturity score identifying late Magnetic resonance assessment of hypothermic neuroprotection preterm infants in low- and middle-income countries amongst babies born inside or outside of a cooling centre: a secondary Dr Vaisakh Krishnan and team analysis of the HELIX Trial Phoebe Ivain This project developed and validated a scoring system based on easily identifiable physical characteristics for identifying late preterm infants from term This study set out to assess whether there were any differences in the severity infants in South India. This was a huge task involving over 2000 babies! The of brain injury between babies born in cooling centres and in non-cooling authors found 6 easy-to-identify physical characteristics that can accurately centres in In South India. The purpose of this is to assess whether differences identify late preterm infants from term infants. in neonatal care and need for transport affects the babies’ outcome. The authors found that, the outcomes were, in fact, not different. What this means for LMIC: This project is affordable, replicable and teachable, meaning it has such a wide applicability in community settings. It is What this means for LMIC: This is in support of the fact that the reason also a game changer for assessing infants with neonatal encephalopathy as cooling does not improve outcome, as found in the HELIX study, is not this does not require any neurological assessment. attributable to factors such as care intensity and transportation. 7 PREVENT Quarterly Newsletter

May 2022, Vol. 9 ECR Initiatives Grant Writing Workshop With focus on research skills development, we organised a 4-days workshop on 'Grant writing' from 19 to 22 April 2022, in collaboration with IIHMR Delhi and Imperial College London for early career researchers to lead them towards a right grant application process. The sessions were moderated by experts from NIHR, ICMR, IIHMR, Liverpool School of Tropical Medicine, Bill & Melinda Gates Foundation and Imperial College London, which covered important aspects of grant writing including the preparation of a good application, critical appraisal of grant application, Institutional funding opportunities at ICMR and career development opportunities for LMIC researchers within NIHR. Clinical Practical Assessment for Medical Undergraduates Our doctoral fellows at Department of brain sciences, Imperial college London – Dr Vaisakh Krishnan and Dr Vijay Kumar volunteered as examiners for the 2022 clinical practical assessments for 2nd year undergraduate medical students at Imperial College London. The examination was conducted as an observed structured clinical exam covering multiple system examinations and was an academically enriching experience for fellows. 8 PREVENT Quarterly Newsletter

May 2022, Vol. 9 ECR Initiatives Department of Health & Social Care Meeting Pallavi and Vaisakh, our doctoral fellows. took part in a panel discussion organized as part of the internal Department of Health and Social Care meeting on the 26 May 2022, where ECRs (both global and domestic) were invited to speak on their career to date and how NIHR funding has impacted their career. The panel included NIHR Global Health Research Academy members who worked on an NIHR-funded Unit, Group, RIGHT or HPSR Programme award, or an Academy member who had received an award from NIHR in the past. The ECRs also discussed their experiences, challenges and opportunities related to academic network building, mentoring, career progression and peer networking. NIHR Global Health Research Engagement Pallavi Muraleedharan, Project Manager and Doctoral Fellow of PREVENT, joined the NIHR Global Health Research Training Steering Group as a Global Health Research Member representative. On behalf of the PREVENT team she also presented our experience of delivering Research Capacity Strengthening (RCS) activities as part of the NIHR award for the 'NIHR Research Capacity Strengthening - A Good Practice Example' session of the NIHR Global Health Research Training Forum 2022 held on 26th April. This session elaborated on the details of the RCS activities, the rationale behind the activities, key challenges and success stories. 9 PREVENT Quarterly Newsletter

May 2022, Vol. 9 News to Celebrate! Dr Sutapa’s International Inspirational Women Award We are excited to share that our collaborator Dr Sutapa B Neogi (Director, IIHMR Delhi) was bestowed the Best Woman Researcher in Public Health Award by GISR Foundation, for her priceless contribution towards the field of Public Health during the 3rd International Inspirational Women Awards Ceremony 2022. Dr Savitha's Career Achievement Vani Vilas Hospital Bengaluru is now led by Dr Savitha C (the site principal investigator of PREVENT Bengaluru) from April 2022 as she earned a promotion to the post of Medical Superintendent. Her achievement reflects her strong leadership efforts and unwavering dedication and enthusiasm towards her career. We are proud of her achievement! 10 PREVENT Quarterly Newsletter

May 2022, Vol. 9 The Transformational Path Our Neonatal Clinical Research Fellows made to travel to UK to attend the ILAE Neonatal EEG course entitled. \"EEG in the First Year of Life-From Newborn to Toddler\" in March 2022. This was a knowledgable platform for them to sharpen their EEG interpretation skills and also gave them opportunity to meet neurologists, clinical neurophysiologists, and neonatologists who deal with neonates and infants with seizures or epilepsy in different countries. The Neonatal Neurology Research Fellows of PREVENT with Dr Ronit Pressler, the pioneer in Clinical Neurophysiology The workshops and discussions with delegates from across the world helped the fellows to share their research interests and also to detect the different varieties of cases and distinguish the practices followed worldwide. The workshop had an interesting session for one to one case discussion and about EEG requirements. This enhanced learning experience will definitely help them for seizures identification and decision making of management of neonatal seizures. The team also won the quiz competition held at the end of the course, which reflects their sound experience gained by being part of PREVENT study. 11 PREVENT Quarterly Newsletter

May 2022, Vol. 9 Next Quarter The next quarter (June - Sep 2022) will mark the active run of the care bundle implementation phase of the PREVENT study across all sites. Meanwhile, in collaboration with global researchers from different disciplines, we aim to organise various community engagement activities and academic advancement programmes like workshops and webinars for the staffs and PhD students. 12 PREVENT Quarterly Newsletter