#343 - Investigating preterm birth and readmission to the PICU (Dr. Tim Van Hasselt)

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. 

(https://timms.le.ac.uk/preterm-birth-and-paediatric-intensive-care/)

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: Hello everyone, 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 take a moment of happiness that our podcast is attracting a lot of fellows globally.

We actually have a fellow from the University of Leicester today. He's a neonatal subspecialty registrar, which is a fellowship equivalent. He's here to talk about his research interests on long-term outcomes of children who receive neonatal care. He’s used large databases for this and is grant-supported by the National Institute of Health Research. Welcome, Dr. Van Hasselt. Tim, how are you doing today?

Tim Van Hasselt: 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. Thanks so much for the invitation. It's really exciting to be able to talk to you and, hopefully, for people around the world to find out a little bit about what we're doing in the UK and some of my research.

Srirupa: I always say it brings me so much joy to highlight fellows globally in this podcast, just to discuss what's going on everywhere. I think that all of us—fellows and neonatal trainees—want to find something fantastic that resonates with our research interests.

I'd like to first understand your training a little bit. 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?

Tim Van Hasselt: 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. It’s a little bit different from the US. We go straight from A-levels at 18 into medical school. Medical school takes five or six years. Then you start as a doctor and complete two years of different rotations through general medical and surgical specialties—colorectal surgery, renal medicine, A&E, and so on. You do six of those jobs over two years.

I started in 2012, then entered pediatrics in 2014. At that point, pediatrics training was eight years; it has since been reduced to seven. That means the quickest time from leaving medical school to being a consultant—equivalent to an attending in the US—is now nine years. That’s longer than in the States, though we spend fewer years at college and work is limited to 48 hours a week.

I’ve slowed that down by doing a PhD, which added extra time. If I hadn’t done that, I’d be an attending by now, but instead I have another two years or so.

During pediatric training, we rotate through general pediatrics, subspecialties, emergency, NICU, PICU, and even community pediatrics. At the end, there’s a competitive process for subspecialty training. If you don’t do that, you become a general pediatrician, perhaps with a special interest, but to work in NICU or tertiary surgical units you need subspecialty training. That is the final three years of training. That’s what I pursued—and that’s when I got into research.

Srirupa: That’s fascinating. We all end up as neonatologists, but the pathways differ so much. I was most curious to know more about your PhD, because that sounds less like a “slowdown” and more like a step up. It seems that linked you to your current project as well. Why don’t you share what got you interested in pursuing a PhD and this project?

Tim Van Hasselt: I’d done some clinical projects—QI projects, audits, and service evaluations—while training in the Midlands, a diverse and often deprived region in the UK. During subspecialty neonatal training, I learned about the National Neonatal Audit Project (which looks at rates of IVH, are units giving steroids appropriately, etc.) and the National Neonatal Research Database (NNRD), which gathers data from all neonatal units in the UK.

That excited me more than lab research I’d done in medical school. I applied for a trainee rep position on the NNRD board, and after my first meeting, I reached out to Professor Chris Gale at Imperial. He connected me to Dr. Sarah Seaton at Leicester, who became my PhD supervisor. She was already working on data linkage between neonatal and PICU datasets.

At the same time, I was caring for extremely preterm infants—22–23 weeks—right as the UK began offering intensive care at that threshold. Then I rotated to PICU, and would see the same patients there. And I thought, 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. I realized we didn’t have good data on how often NICU graduates end up in PICU. That question became the basis of my doctoral fellowship.

Srirupa: Yes, and like you said, so much of research begins with a simple email. That’s such an important lesson for trainees. Email is very powerful. 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. So tell us more about the project itself—the NICU–PICU relationship.

Tim Van Hasselt: We're really lucky that the NHR agreed. Getting the funding was really changed my career direction completely. So I'm very grateful to the NHR for that opportunity and for Sarah and Chris for helping put it in place.

The big question was: if a baby is born <32 weeks, survives NICU, and goes home, what’s the chance they’ll need PICU later? There just wasn't that data. We had no idea. We could ask people and people thought, well, it could be 25%, who knows? We're relying on anecdotal perceptions. We just feel like it happens quite a lot, but there was no data. And the data is important for families to discuss, prepare, and answer any questions. It’s also important for the wider health service to know how to change the pediatric services that we provide for children and families.

To answer this, we linked NNRD with the PICANet (Paediatric Intensive Care Audit Network) dataset, which records all UK PICU admissions. There are fewer PICUs than NICUs 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 more children might be receiving non-invasive forms. We have a sort of smaller, sicker cohort of children in our PICUs here.

NHS England worked to link these datasets and create an anonymized 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. That gave us a birth cohort of 46,000 preterm infants born less than 32 weeks (2013–2018). Of the 40,000+ who went home, 2,308 (5.7%) had a PICU admission after discharge. Importantly, 80% of those were unplanned. That’s very different from planned surgical admissions, e.g. a planned inguinal hernia, and represents a real shock for families. The risk scaled with gestational age—10% for <24 weeks, down to 3.3% for 31 weeks. BPD, surgical NEC, and IVH/brain injury also increased risk.

Srirupa: The infographics you made are fantastic, and available for public use, correct?

Tim Van Hasselt: 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: That’s such a valuable resource, and important for parents to know prior to NICU discharge. What was it like working with families on this research?

Tim Van Hasselt: It was essential, because NHR won’t fund projects without patient and public involvement. You won't have funding if you don't go to the public 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 (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.

Families helped shape our methods, interpret results, and co-design the outputs. Some wanted every number; others preferred reassurance. Many families saw the statistics and said, sounds like it's not going to happen to me, so I'm not going to worry about it. It reminded us to individualize counseling—these tools aren’t prescriptive. Families also wanted empowerment, not just statistics. That’s why the infographics include prevention tips and links. Many parents appreciated feeling like they could do something proactive. Families told us they wanted simple statistics—percentages, per-100 numbers, donut charts—and, importantly, actionable advice. So the infographics also link to BLISS resources on preventing respiratory infections and recognizing signs of illness.

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. Maybe just bit of assessment for bronchiolitis and a short stay, but maybe that'll be helpful as well to give families a balanced view of although the PICU can be the most scary, most families will experience a bit of respiratory illnesses as well.

Srirupa: That’s fantastic. Looking at your publications, you’ve carved out such an important niche on risk factors for PICU readmissions in neonates. Congratulations on such a fantastic list of publications. And if I’m correct, your main paper was recently published in Archives of Disease in Childhood: Fetal and Neonatal Edition, right?

Tim Van Hasselt: Yes, that was the main paper, and it was also discussed on The Incubator podcast. Since then, we’ve published on seasonality in JAMA Pediatrics Open and on direct NICU-to-PICU transfers in Archives again. Conferences have been great too—people constantly suggest new research questions we can answer with these linked datasets.

Srirupa: That’s wonderful. Tim, thank you so much for joining us today and for sharing your journey and research. Good luck with your ongoing projects and the many important spin-offs that will surely come from this work.