#343 - Investigating preterm birth and readmission to the PICU (Dr. Tim Van Hasselt)
- Mickael Guigui
- 6 hours ago
- 20 min read
Hello friends 👋
In this episode, I had the pleasure of speaking with Dr Tim Van Hasselt, who is now a NIHR Academic Clinical Lecturer and Neonatal Subspeciality Registrar (fellow-equivalent) at the University of Leicester, UK..
Tim describes his training in the UK, his pathway to doing his PhD in investigating the impact of preterm birth on readmissions to the PICU. We talk about how he went about finding his mentor and how the project came about. He used two national databases and investigated his research question, where he ultimately found that the odds of unplanned admissions to PICU were greater in the most preterm and those with significant neonatal morbidity. With this data, he, along with his team were able to create infographics that could help educate parents of NICU graduates.
He also describes his experience interacting with parents who provided valuable feedback for the infographics and for his project. Dr Van Hasselt has successfully published his data in the Archives of Disease in Childhood. Paediatric intensive care admissions of preterm children born | ADC Fetal & Neonatal Edition
He also has several publications related to this topic and has presented his work in several National conferences.
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Short Bio: Tim is an NIHR Academic Clinical Lecturer and Neonatal Subspeciality Registrar (fellow-equivalent) at the University of Leicester, UK.
His research interests are in the long-term outcomes of children who receive neonatal care, using large routinely-collected datasets.
Outside of research and looking after babies in the neonatal unit, Tim spends family time on trips out with his wife and children, and tries to find time to do some running and climbing boulders.
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The transcript of today's episode can be found below 👇
Srirupa (00:01.174)
Hello everyone, this is again. Welcome back to another fabulous episode of Rupa's Fellows Corner. I am very excited to welcome another guest speaker today. But before that, let me again have a moment of happiness that our podcast is attracting a lot of fellows globally. So we actually have a fellow from the University of Leicester today. He's a neonatal subspecialty registrar, which is a fellowship equivalent.
And he's here to talk about his research interests on long-term outcomes of children who receive neonatal care. And he's used large databases for this. He's grant supported by the National Institute of Health Research. Welcome Dr. Van Hasselt. Tim, how are you doing today?
Tim Van Hasselt (00:49.134)
Good, yeah, so I'll say good afternoon from us in the UK. I think it's good morning for you guys in the States. Yeah, thanks so much for the invitation. It's really exciting to be able to talk to you and yeah, for people hopefully around the world to find out a little bit about what we're doing in the UK and some of my research. That's really exciting.
Srirupa (00:57.972)
Yeah.
Srirupa (01:10.614)
Yeah. Yeah, no, that's amazing. And I always say that it's so much of joy for me to bring fellows globally in this podcast, just to kind of discuss what's going on everywhere. And I think that all of us, all fellows and all Neonatal trainees want to find something fantastic and find something that resonates to their research interests. I'd like to first understand your
training a little bit. And I know you mentioned that you're doing a fellowship equivalent, which is called a neonatal subspecialty registrar. Could you share with us your training so far? I would love to understand that.
Tim Van Hasselt (01:48.558)
Okay, so I'll try and explain the UK training system. It is a little bit complicated, but I'll explain what I've done. And yeah, it is a little bit different from the US. So when we leave medical school, medical school we do straight from our sort of A levels, which is from 18. So we go straight to university, do medical school, and that takes five or six years. And then you start as a doctor, and then you have two years of...
different rotations through general medical, surgical specialties. like I've gone to colorectal surgery, know, renal medicine, A &E, all these different specialties and you do six of those jobs over the two years. So I started that in 2012 and then I entered pediatrics in 2014. And then at that point, the pediatrics training was eight years. It's just been reduced to seven years. So that means that the...
quickest time from leaving medical school to being a consultant, which is like our attending in pediatrics, is now nine years. So I think that's a bit longer than you guys in the States. Although we spend less years at college and we have limits on our work of 48 hours a week. So I guess it probably all works out around the same in the end, but it's just different.
Srirupa (02:58.634)
Yeah, it's almost a little more than double, I would say. It's amazing.
Srirupa (03:09.525)
Mm-hmm.
Tim Van Hasselt (03:15.694)
But I've slowed that down by doing a PhD which added some extra time. So even now I've still got... Well it slows... It slows my time down until I was finished. So if I hadn't done the PhD I would be in attending by now. But I'm looking at another two years or so.
Srirupa (03:20.97)
I don't know if you would call that a slow down, would you? But sure, we'll call it a slow down.
Tim Van Hasselt (03:38.446)
So yeah, that's, and during our pediatric training, we go through, I guess the same in the States, we go through general pediatrics, we might go through some specialties, maybe some emergency department, NICU, PICU, and we do a bit of community pediatrics, which is like following up children in the community who might have developmental delay or neurodevelopmental concerns and things.
So we get quite a broad training. And then at the end, we have this subspecialty training, which is a competitive process. And that's for the specialty. So if you don't do that, you become a general pediatrician. You might have a special interest. And maybe you'll work in a level one special care baby unit or nursery. You might see some babies. But if you want to work in a NICU or a particular tertiary or veterinary surgical unit,
I guess like a level three or four in the States you'd call it, then you generally have to do the subspecialty. And that is the final three years of your training. So for me, I got into my subspecialty NICU rotations. And then from there I decided to enter research. that's, yeah, I'm happy to talk more about. I hope that makes sense to you.
Srirupa (04:36.288)
Mm-hmm. Mm-hmm.
Srirupa (04:55.35)
That is, yeah. Yeah, no, that's amazing. And it's so fascinating that, you know, we all end up being unitologists, but the pathway to get there takes several like turns and roundabouts and different other destinations. But I was most curious to know more about your PhD because that is a wonderful, you call it a slowdown, I would say a step up. So.
Tim Van Hasselt (05:10.264)
Mm-hmm.
Srirupa (05:22.326)
And it seems like that is what linked you to your current project as well. So why don't you share with us what got you interested in doing a PhD in the first place and what got you interested in this project that you're going to talk to us about.
Tim Van Hasselt (05:27.726)
Mm-hmm.
Tim Van Hasselt (05:36.352)
Okay, so yeah, I suppose maybe call it a slightly sideways step into like a clinical academic path because before I was just on a clinical path and I've done some, you know, quite a few projects like QI projects, service evaluation, know, audits looking around my region where I was in the Midlands of the UK, which is, I guess the Midlands is
I don't know if you compare it with the middle of the US, but it's an area where there was a lot of industry in the past. And now there's a very sort of mix of ethnicities, there's some quite deprived areas. And this is the sort of region I've been training throughout. So yeah, I was doing these different clinical based projects. And I got into my neonatal subspecialty. As part of that, we had to learn about some of the national things going on in the UK.
So we have the National Neonatal Audit Project, and that gathers data from all the neonatal units in the UK and sort of does a benchmark. So, you know, what's the rates of IVH in different units in different regions? You know, how many regions are giving steroids at the right rates antinatally? And there's also something called the National Neonatal Research Database, and I learned a bit about that in this process. And that gathers data electronically from all the neonatal units.
Srirupa (06:53.76)
Mm-hmm.
Tim Van Hasselt (07:03.086)
And so when I heard about that, I thought, you know, I've done some laboratory research at med school. did some liver lab work with, you know, cells and, you know, chopping up bits of liver. And I did that for a year and it was okay, but I didn't really think it was for me. But I thought this is really exciting because I'm really interested in, you know, neonates, neonatology, how can we improve things? And we've got all this data.
It seems to make sense that going into research with that is, it just made sense to me. So, then I suppose that the story of how I got into it was really just taking some chances. So I took a chance and applied for the training rep position on the NNRD board that was advertising. and I wasn't, you know, sure whether I'd get that because I didn't have any formal research experience, but they said, yes. I got onto that. And after my first board meeting, one of the,
people on it who's now prof, Chris Gale, who's an Imperial. I just sent him an email because he knew one of the bosses I was working with and I just said, you know, you're on this call. I'm interested in research. know that Imperial, who hosts this national neonatal data set, they have the data sort of stored there, whether it comes from all around. You know, I'm interested in research. Can you, can we?
me touch with someone or you know any projects around and he then said you know well I know that there's someone called Dr Sarah Seton who went to be my supervisor she's at Leicester she's got this interesting project looking at PICU data and neonatal data and at the time it sort of tied in what was happening with my training so initially I thought maybe I could look at
Srirupa (08:43.264)
you
Tim Van Hasselt (08:56.558)
changes in neonatal ventilation and non-invasive things. That was my initial sort of research question. When Chris mentioned about having the neonatal and the PICU data, this sort of really chime with what was going on my training because I'd worked in Oniku and we'd had one of the early 22, 23 week babies because just at the time in the UK, we were just starting to offer 22 week resuscitation and intensive care.
Srirupa (09:24.064)
Mm-hmm.
Tim Van Hasselt (09:26.218)
after BAPM, the British Association of Perinatal Medicine, had made this national document, which I think is similar to in the States where more and more units are offering 22-week babies intensive care. So I looked after these tiny babies and my next rotation was actually on PICU. And so here, similar, I guess the States PICU looks after babies once they leave NICU all the way up to 16. But I was looking after
Srirupa (09:31.766)
Mm-hmm.
Mm-hmm.
Mm-hmm. Yeah, we are.
Srirupa (09:53.376)
Mm-hmm.
Tim Van Hasselt (09:55.522)
the same patients would come across from neonates to be ICU. And I thought, okay, well, you know, how often does this happen? Do we know about this? Is this something we can talk to parents about? We don't seem to tell parents about this in any formal way. We don't have data. So that was, you know, that got me thinking and reaching out to Chris, who was my external PhD supervisor and Sarah, who's my primary supervisor at Leicester.
Srirupa (10:09.856)
Mm-hmm. Mm-hmm.
Tim Van Hasselt (10:24.994)
we put together this proposal to the NHR for a doctoral research fellowship to get me PhD and let me do this research. And this was also all during COVID as well, so it was all virtual. And I didn't actually see, I'd never been to Leicester University or Leicester City until I started my PhD because it was in lockdown, you weren't allowed to go. So it's crazy now looking back, we did all these things virtually.
Srirupa (10:49.75)
Yeah.
Yeah.
Tim Van Hasselt (10:55.379)
But I suppose there's benefits to that as well because it means we can reach out more over Zoom and make these connections.
Srirupa (10:55.382)
Yeah.
Srirupa (11:04.042)
Yeah, no, absolutely. think, every researcher I've talked to their turn of events started with an email, I would say it just started, started with an email and, know, and the rest is history because you've gotten so many opportunities because you reached out and which is good. So, and always tell this to trainees that an email is very powerful, like you reaching out to a person.
Tim Van Hasselt (11:13.423)
Yeah.
Srirupa (11:29.366)
expressing your interest is very powerful because you'd be surprised how many people are there to support your research and your ideas, which is wonderful. Okay, and so the rest is history with you pursuing a PhD, which is fantastic. Tell me a little bit about the project. And it's such an interesting question about the NICU-PICU relationship, which is so important to families. I totally agree. And I would love to hear more about your project.
Tim Van Hasselt (11:47.501)
Yes.
Tim Van Hasselt (11:57.176)
Thank you. Well, yeah, we're really lucky that the NHR agreed, you know, going through the application process, the interview and getting the funding was really changed my career direction completely. So I'm very grateful to the NHR for that opportunity and for, you know, Sarah and Chris for helping put it in place and for Lester as well. So really it goes back to that question was
quite simply, if you've got a baby who's born very preterm, less than 32 weeks, and they're getting ready to go home from neonatal care, as thankfully most of our babies do, what's the chance that they will end up coming back and need more intensive care in PICU after they go home? And as I there just wasn't that data. We had no idea. You know, could ask people and people thought, well, it could be...
I know it could be 25%, who knows? It seems a lot because all we're relying on is our anecdotal perceptions where as clinicians we just felt like it happens quite a lot, but there was no data. And the data is important for families obviously to discuss and prepare, answer any questions. And also for the wider health service as well to know with changes in neonatal care, how do we need to change the pediatric services that we have for...
Srirupa (13:18.411)
Mm-hmm.
Tim Van Hasselt (13:21.71)
for children and families as well. So to go about this was really a case of using this novel data linkage that Sarah Seton at Leicester had put together as part of her NIHR Advanced Fellowship. And it brings together the NNRD, the National Inertial Research Database that I talked about, that has data for all the children.
Srirupa (13:46.41)
Mm-hmm.
Tim Van Hasselt (13:48.302)
in England and Wales at this point, although subsequently it's the whole of the UK. All of the children since 2013 were in this dataset, all of their neonatal admissions, events during and discharges. But we also have P-Connect. So P-Connect is a PICU audit network dataset. And this has been running for over 20 years now and is hosted by the University of Leicester and University of Leeds.
And again, it's a really significant research asset because again, you've got every single admission, discharge and all the events during stay for all the PICUs in the UK. And obviously there are fewer PICUs than the inatal units in our system because PICUs really provide intensive care for very unwell children. The majority of the children in PICUs are invasively ventilated, which I believe is slightly different in the US where
Srirupa (14:28.47)
Mm.
Tim Van Hasselt (14:46.638)
More children might be receiving non-invasive forms, but we have a sort of smaller, more sick cohort of children in our PICs here. So NHS England worked to link these datasets and create an anonymised to the joint dataset that we're able to use and we have access to here at Leicester. And that enables us to answer so many research questions, including mine.
So we basically used it in my PhD to create a big birth cohort. So all of the children born less than 32 weeks in 2013 to 18 inclusive were admitted to neonatal units were included. And obviously that's the majority because if you're born less than 32 weeks, you will go to neonatal units. We didn't include the small number of children who died before admission, but you
Thankfully, that's actually a small number of babies. And this created a cohort of over 46,000 children. So it's really significant and able to do quite robust statistics and things on that group. And then this was linked to the peak net. So we could then see of those children, how many went home, which was about over 40,000. And then you've got some children, obviously,
Srirupa (15:45.823)
Mm-hmm.
Tim Van Hasselt (16:14.222)
babies died before they went home. Some babies might have been transferred to a pediatric ward direct without going home, all of those things. But most children went home. And then of that cohort who went home, how many then had PIC admissions? And so that really gave us our main headline figure. I don't know you want to talk about the methodology, then give away my results. I suppose they're out there now. So
Srirupa (16:39.254)
Mm-hmm.
Tim Van Hasselt (16:42.252)
There were 2,308 children who were admitted to BICU after they went home. So that's 5.7 % of the whole cohort. But it was interesting because we could get even more granular detail from these data sets. How many of those were unplanned admissions and how many were planned? We thought this might be quite important. And throughout the research process, we talked to families during building my grant, during the methods, during the results, interpreting the results. We've had the families.
Srirupa (16:51.807)
Mm-hmm.
Tim Van Hasselt (17:12.398)
sort of alongside us all the time. And it's probably more helpful to talk about those unplanned admissions. Because if you go home from neonates services and you know, you you're to come back because there's a hernia, ingual hernia needs needs fixing, and you're going to book an ICU bed in two weeks, that's going to be a very different conversation than whether baby goes home. And then a few weeks later, they get bronchiolitis and they go
to emergency department, they're being intubated, that's a really different, and in terms of psychology, that's a really different experience for families. So interestingly, the majority, around 80 % of these admissions were unplanned. So actually, they were a surprise for families. They weren't expecting it. And we also could see just with the description of the stats, not doing these.
special statistical testing, you can see that when you look at the proportion of children had unplanned admissions to PICU, those born less than 24 weeks, it was 10%. And it went right down to 3.3 % for those born at 31 weeks. So it really just scales with the gestation. The smallest babies have the higher amount. And then we could do various multivariable analysis looking for other features. So having BPD, bronchoprol...
pulmonary dysplasia increases the risk. If the baby's had NEC with surgery during their inital stay, that increased the risk. And having brain injury, so meningitis or significant IBH, that increased the risk as well. But really those sort of just those descriptive statistics, they gave us the figures that we thought would give for...
the infographic designing stage and sort of the output of the study for families.
Srirupa (19:12.342)
And just for readers to say that the infographics are fantastic and I think that I talked to Tim and Tim said that is available for public use. Correct Tim?
Tim Van Hasselt (19:16.11)
you
Tim Van Hasselt (19:24.666)
Yeah, so you should be able to share through the podcast and through social media the link to that. And they're just available as PDFs, all the infographics, co-produced with families and healthcare professionals. And there's different ones for different gestational age for all less than 32-weekers.
Srirupa (19:46.122)
Yeah. And that's, that's such valuable information for, for physicians to discuss with families, because like you rightly pointed out, when we counsel families at the time of discharge, I think it's valuable for them to know that there is a risk for readmission and, know, if your baby is born less than 32 weeks, it's a lot higher readmission rate with the PICU. And so it's just important for them to get a little idea. And I think it's so valuable.
These infographics are fantastic. And I think it would be such a valuable resource. In your experience, sort of interviewing and interacting with parents, how was your experience with that? I think research comes as a package where you're interacting with so many individuals, right? Like you're interacting with the medical professionals in your team. But I personally would love to hear perspectives of your interaction with parents because, you know, it's such a...
valuable interaction and such valuable inputs that you get from them. Could you share with us your experience of that?
Tim Van Hasselt (20:49.376)
Yeah, so as I mentioned before, we've had families sort of input throughout the whole research process and I think that's part increasingly of research and certainly the funder funding in the UK with the NIHR, you know, it's essential. You won't have funding if you don't get the, if you go to the public, go to families and hear what's important to them.
because otherwise we're not producing research that's actually important to the people who benefit from the research. So we have multiple family groups and we're very fortunate to recruit our families who took part from BLISS, which is the UK charity for sick and pre-term babies. BLISS did so much work to promote our research and reach out to families and there are loads of families who've gone through the neonatal.
sort of experience and then want to give something back through research. So we're really, we're really grateful for all the families who took part. And as I say, the experience is sort of really, it gives you an insight into what people think about these results, but also the range and diversity of families. And I think it's important just to reflect on, you know, when we counsel, we say we're going to counsel families, actually all the families are different.
And there are some families who said that having any figures is good, they want to know all the figures. If they're going home from the nursery, they want every figure, all the information. And some families said, you know, it looks like the risk for my baby doesn't look like it wasn't that much. It's just quite reassuring. Most babies don't go to PIC, so I'd prefer not to know about that. But I think that just means that we need to reflect.
you know, if you're using these tools, we're not instructing, we're not saying that, you know, everyone has to deliver all this information to every family. I think it depends on the family. depends where they are, what they benefit from, whether it would just be anxiety that's not, you know, necessary, or is it something that's empowering? So when we were co-designing the infographics working with the families,
Tim Van Hasselt (23:09.9)
A lot of the things that we heard from was keeping it really simple, the statistics are just simple, so just a percentage or out of every 100 babies who go home from neonates born less than 24 weeks, 10 happy ICU admissions. And you know, it quite a simple way. They advised us what sort of graph to use, the families generally preferred the donut chart that we've got on there. The other thing that they really wanted was
not just to be passive and just receive this information and not be able to do anything with it. They said, well, how can we get something useful from it at the same time? So if you look at the infographics below, it gives a little bit more information. So it says most of these are chest infections, which is what we found from the data. But also it has a link to bliss resources for simple advice for families to avoid respiratory infections, you know.
advice about visiting, know, don't let someone who's coughing and sneezing come into your house, you know, the aunt who's going to cough and sneeze all over your baby, tell them to stay home. Maybe don't go to that big children's party with your newly discharged DNA. You know, just simple things. And also there's some advice on, you know, what to look out for in your baby when you go home. So Bliss has got all this amazing advice and all we've done is have a link and a QR code that they can scan.
on their mobile to get to that because it just gives that there's something that they can do about it. It's not just a figure that they can't do anything about. At least there's simple things that they can have a bit of feeling empowered. You know, because having a pre-tempo is not always that empowering. They're just going through things. So that's the feedback we got. And as I say, it was interesting that for many families, they say, well, this
sounds like it's not going to happen to me so I'm not going to worry about it and I guess that's fine as well, everyone's different.
Tim Van Hasselt (25:13.454)
And especially as when we went into the research, no one knew. And if I'd find that of all the very small babies, like 25 % came back to PIC, I wouldn't have been surprised. So it's probably lower than we thought. Obviously, these are the babies who go home straight from neonate. So they're probably more healthier because some babies might stay in hospital a long time and go to the spiritual ward, maybe have long term ventilation.
Srirupa (25:26.646)
Mm-hmm.
Tim Van Hasselt (25:41.996)
these babies are going home, although some of them are going home on oxygen even. But yeah, mean, overall it is reassuring. Following on from this project, we have looked at other factors, looked at the timing, whether it's more in winter and autumn, which it does look like it is, and we've published on that. We're doing some more work on the morbidities. We've also got a paper that we've submitted.
So hopefully that will be coming out as well, looking at all hospital admissions as well. Because PICU is obviously just the tip of the iceberg, but it does look like most families of very pre-term babies will have at least one episode of hospitalization for the majority. Maybe just bit of assessment for bronchiolitis and a short stay, but maybe that'll be helpful as well to give families a...
like a balanced view of this is the worst that can happen. Obviously PIC was the most scary, but actually most families will experience a bit of respiratory illnesses as well.
Srirupa (26:50.398)
Yeah, no, and it's so fantastic. I'm just looking at your Google Scholar and I see all of these publications that have a theme of what are these risk factors in neonates that increase the risk of PICU. So it seems like you're carving out a very, very important pathway for your career. And I applaud you for taking up this topic because it's such an important topic for clinicians, for parents, and such important information for us to know.
Congratulations on such a fantastic list of publications that you have achieved for yourself. And I'd also like to highlight that this work that Dr. Van Hasselt had mentioned recently got published in the Archives of Disease in Childhood. Is that correct? I feel like we looked at this paper and I specifically read this paper, so I remember this. But is that correct that you recently published your work as well?
Tim Van Hasselt (27:45.176)
The, yeah, so this main paper was in archives of disease and childhood of fetal and neonatal. And it was discussed by Ben Daffner on the incubator, which was amazing to hear. And then there's been some subsequent papers looking at the seasonality and timing of neonatal discharge, and that was in JAMA Pediatrics Open.
and then one on the babies who transitioned straight from neonatal to PICU, the small number of babies that was in archives again. So yeah, as I said, having this resource is just amazing because you can answer so many research questions from having this linked data set. And also when I go to conferences like the Back-end Conference or the Pediatric Critical Care Society Conference,
or ESPNIC in Europe, you know, people would either ask in presentations or come up afterwards and they'd say, what about this? What about that? Can you look into X and Y? So you don't have to think about the research questions because people just bombard you with things they want to know. So I think there was just a space, there was a niche, guess. And I suppose succeeding in research, I suppose, a bit of
luck because the niche comes up, the opportunities come up, but also, like you said before, taking a risk and saying, I'm going to step into it and see whether we can fill that niche and then the ball keeps on rolling.
Srirupa (29:26.41)
Yeah, no, absolutely. This is fantastic. And I'm so glad that you could join us today to discuss all of your, I wouldn't call it challenges because they've been wonderful. So a lot of challenges, but still good challenges to have as you explored your research passions throughout your training. Thank you so much for joining us and good luck with all of your other fantastic spin-off projects that you get from this main project. Good luck.
Thank you for joining us.
Tim Van Hasselt (29:55.928)
Thanks very much. Thank you. Bye.