Professor Jani's project

Fetal Medicine - Brugmann Foundation - Queen Fabiola Children's Hospital

 

The proceeds of the Snowman events since 2011 have been donated to the Brugmann Foundation/Queen Fabiola Children's Hospital, to help the work of Professor Jacques Jani, a specialist in neo-natal care, concentrating on prematurity. Prematurity is responsible for more than half of all neonatal deaths; advances in neo-natal care have considerably improved survival of extremely premature infants, but a significant risk of handicap and disability in survivors remains,with an associated social and economic burden. Professor Jani's research aims to elaborate a more effective strategy for identifying women at risk of premature birth and to intervene in the early weeks of pregnancy to improve survival chances.

In foetal medicine, the big challenge is how to discover early, and without intrusion,whether a baby suffers from dangerous conditions. Pregnancies in women over 35 are becoming more common but present a higher risk of chromosomal and other problems. How to identify the foetal cells in the mother's blood? Invasive tests carry a 1% chance of miscarriage and are thus to be avoided. Instead,more sophisticated screening tests have been developed to select mothers at high risk. By focussing on more precise indicia than maternal age, invasive tests are carried out on only a tiny percentage of notionally at-risk mothers. Professor Jani is the only specialist in Belgium doing such work. The technique more accurately targets mothers at risk, and results in a lower risk of miscarriage. Pre-eclampsia is a killer of mothers. Professor Jani and his team can now detect risks of pre-eclampsia at 11 or 12 weeks into pregnancy, ten weeks earlier than previously. Mild medication (aspirin) can be prescribed, and can prevent the dangerous surge in blood pressure after week 20.

Premature babies run a higher risk of death or handicap. As 85% of them are first-time pregnancies, there is little value in focussing on those who have previously delivered prematurely. Sutures on the cervix, though widely used, are ineffective; antibiotics for vaginal infections increase the risk of premature birth. One crucial measurement is the length of the cervix. If that is accurately and objectively measured and appears short, a dose of progesterone once per day is prescribed: the rate of prematurity drops 44%. Professor Jani and his team believe that they have seen a very impressive percentage drop in the rate of premature births.

I had the opportunity to meet Professor Jani in October 2012. The most astonishing part of my visit was a demonstration of foetal surgery. MRI imaging to detect abnormalities in foetuses can fine-tune an ultrasound assessment. Babies with an otherwise low chance of survival are selected for an intra-uterine operation. Foetal anaemia requires a blood transfusion. Non-growing lungs are inflated within the womb: a tiny balloon is inserted through the mouth and down into the airway of the baby, and inflated to increase pressure on the lungs. This in turn forces them to grow so that at the moment of birth they are strong enough to begin working. Before birth, the balloon is removed. Without such intervention, the lungs would be incapable of fully inflating and the baby would die within a few minutes of birth. Alternatively,where twins are developing with danger to one of them, the two foetuses can be separated so that each twin can grow large enough separately. Truly amazing techniques.

 

Ian Forrester