Advancing neonatal care: platelet research by Dr Daniel O’Reilly targets preterm infections
Thursday, 14 September, 2023
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In August Dr Daniel O'Reilly moved to New York to take up a Fulbright scholarship at the University of Rochester for four months. A PhD student in the Conway Sphere research group in University College Dublin, and a research registrar in the Rotunda Hospital and National Maternity Hospital, Daniel’s work examines the activation of platelets in the blood to identify preterm babies who will develop infections.
As the eldest of eight children, Dr Daniel O’Reilly already knew plenty about babies before a medical degree at the Royal College of Surgeons Ireland led him into neonatal care.
He vividly recalls helping his parents by pacing the floor bouncing a crying baby sister before trying to put her down to sleep, “hoping for the best and expecting the worst,” he chuckles.
These days Dr O’Reilly’s interest in newborns is academic too, since a graduate internship brought him to University College Dublin in 2017.
“I managed to do some work with the Conway Sphere research group looking at neonatal platelets, with Patricia Maguire and Fionnuala Ní Áinle. Before that, I had no concept about platelets or how important they may or may not be."
“I managed to do some work with the Conway Sphere research group looking at neonatal platelets, with Patricia Maguire and Fionnuala Ní Áinle,” he says, of the professors who spearhead the platelet-based technology platform PALADINTM to reinvent how to find diagnostics in the blood.
“Before that, I had no concept about platelets or how important they may or may not be,” he says, of the tiny blood cells that help the body form clots and stop bleeding.
“Just by chance, I landed in this job, which was wonderful because it really opened my eyes to the potential of platelets in the neonatal field.”
Platelets, he explains, are one of the most numerous cells in the blood and will often come across bacteria in the bloodstream before traditional immune cells do.
Understanding how they might alert those immune cells to take action against infections is part of Dr O’Reilly’s research.
“And whether we can harness that to more effectively determine whether babies are about to develop a serious infection,” he adds.
His PhD in platelet biology also explores the potential usefulness of a “minimally invasive, point-of-care test for neonatal bacterial infection”.
Newborn infections are primarily bacterial in origin and include pneumonia, sepsis and meningitis. They result in over 550,000 deaths every year and preterm babies are most at risk. Most of these deaths can be averted by preventative measures, early diagnosis and antibiotics.
But Dr O’Reilly says current tests used to diagnose neonatal bacterial infections are “sometimes unreliable”. This means, he says, that clinicians are “kind of forced into giving these babies antibiotics and then figuring it out later. In the context of the rise in antimicrobial resistance - that ‘one health’ problem where we're giving antibiotics to animals, we're giving antibiotics to humans - I think it would be really useful if we had a little point of care test that said, ‘This baby is very likely to have a bacterial or fungal infection that we need to treat and this baby's probably not, so we could hold tight for a bit and watch them’. I think that will be quite a big step and would really make us have to change some of the practices that we've got at the moment. I think a test like that is probably a believable, short to medium term possibility.”
A year after beginning platelet research to help improve the lives of our smallest citizens, Dr O’Reilly worked closely with babies in the clinical setting of Cork University Hospital.
“That was a really good education; they see loads of neonates. We got to see lots of well babies, I got to see lots of babies who are a little bit sicker. It was really fascinating and the prematurity piece is always changing. The first baby I ever saw, obviously, was term, thankfully,” he adds, of that younger sister he used to rock to sleep. “But I have looked after 23-week gestation babies, which is very, very small; 400 grams in weight. Those babies are very different.”
The earlier a baby is born, the higher the risk of death or disability. Babies also have fewer platelets in the blood than adults and it is not known exactly why this is or what the full implications might be. Preterm babies have even fewer platelets, and “a lower platelet count, we know, is associated with a poorer prognosis”.
But there are no quick or obvious fixes. Dr O’Reilly points out that Dr Anna Curley, a neonatal consultant in the National Maternity Hospital, led a project that found in 2019 that when preterm infants with a low platelet count were given adult platelet transfusions, they had poorer outcomes than those who were not (platelet transfusions from babies not being technically or ethically possible).
Could baby platelets be produced synthetically?
“If we could do that I would be in Barbados instead of Rochester,” he quips.
“Platelets are very complex. Even though they look like these simple cell fragments they seem to work through a whole variety of mechanisms to activate, and those are not fully understood. There are efforts to make synthetic platelets,” he says. “But what a synthetic neonatal platelet would look like is still up in the air.”
Dr O’Reilly’s research explores the possibility that neonatal platelets do not communicate as well with immune cells as adult platelets do.
“The best evidence for that was produced here in Rochester by the group I am working with led by Professor Craig Morrell and it suggests that one specific immune cell called a monocyte doesn't migrate quite as actively when it's exposed to neonatal platelet transfusions versus adult platelet transfusions. Does that happen in other immune cells too? That’s the question that I’m hoping to address while I’m here. And how or why is that the way it is?”
Listen to the (opens in a new window)podcast.