'Treat patients as early as possible'
‘The younger the patient is when you start treatment, the more there is to win in terms of quality of life and lowering health care costs,’ state Irwin Reiss, head of Neonatology at the Erasmus MC-Sophia Children’s Hospital and Dick Oepkes, Head of the Fetal Medicine section at the LUMC. Together with Jenny Dankelman, professor in BioMedical Engineering, they work on technological solutions to improve fetal and neonatal care.
‘If we can treat children with congenital anomalies in the womb of their mother to make sure they are born healthy, that has many advantages for them personally, for their family, but also for society as a whole,’ says Dick Oepkes. ‘Premature birth is the number one cause of childhood death, and can cause severe chronic illnesses and disabilities in later life,’ adds Irwin Reiss. ‘Therefore our ultimate goal is to prevent premature births all together. A person’s health in later life is largely determined by the first 1000 days after the conception. At Erasmus MC, LUMC and TU Delft we combine our expertise to intervene in this crucial early phase of life. Current advances in technology enable us to develop treatments and perform medical interventions which were unthinkable before.’
Close the hole
‘In case of fetal surgery, the main technical challenge is to make the hole in the amniotic sac as small as possible, since it doesn’t heal, and a damage amniotic sac can cause a premature birth,’ explains Jenny Dankelman. ‘So we are always aiming for smaller instruments, which ideally combine both diagnostics and treatment all in one. Furthermore, we are also trying to develop ways to close the hole we made with our equipment, for example with collagens.’ The technological solutions Dankelman comes up with, often can be applied in other areas as well. ‘Basically, we are working in a wet environment, on soft tissue. If we come up with something to repair the amniotic sac, we could probably also use it to repair some other damaged tissue.’
High level of ambition
Dankelman has been cooperating with medical centres for over twenty years now. ‘In my group, we want to advance clinical science by providing technical solutions. We invite doctors here to show them the technical possibilities, and our technicians are working in the hospitals to experience in what kind of environment and under what circumstances their solutions should work. I got to know Dick Oepkes through my colleague John van den Dobbelsteen. Together we are working on minimal invasive technology to treat unborn babies. For example, van den Dobbelsteen is currently working on a project, ‘3D printing in the womb’, in which he is developing a new way of treating spina bifida by printing a collagen cap onto the back of unborn spina bifida babies inside their mother’s womb, to prevent nerve damage from happening.’ ‘That project nicely illustrates our level of ambition,’ adds Oepkes. ‘We are not satisfied with little improvements of quality of life, we want patients who are now often condemned to spend a lifetime in a wheelchair, to be able to walk and run and lead as normal a life as possible.’
Monitoring and control
In the care for premature infants, the multidisciplinary team is working on subjects like monitoring and automatic decision-making, explains Reiss. ‘Based on accurate measurements we want to identify key decision-making moments for extremely ill children. As humans, we cannot monitor everything 24/7, but with smart sensor technology it is possible to develop personal and automatic monitoring and control systems. For example, we have been working on a system, ‘Technology for the youngest’, that monitors the oxygen saturation levels in premature infants and adjusts ventilation automatically. I highly value the possibilities technology can provide to improve care. That is also why we have added one of Jenny’s former students as a permanent staff member to our team here in Rotterdam.’
The advantage of teaming up with the group of Dick Oepkes at LUMC is also clear, Reiss says, since Oepkes is one of the very few people in the Netherlands who is able to perform fetal surgery. ‘We are often working with the same children and the same parents: here in Leiden when the child is still in its mothers’ womb, in Rotterdam when it has been born early,’ says Oepkes.
I believe with TU Delft, LUMC and Erasmus MC, we have combined the right expertise to achieve major breakthroughs, which will benefit society as a whole for years to come. Prof.dr. Dick Oepkes, Head of the Foetal Medicine section LUMC
‘There are so many diseases which cause damage already before birth. If we can treat those diseases during the pregnancy and immediately after birth, we can prevent all sorts of problems from arising in later life.'
Interview by: Sonja Knols