Lay summary
Perinatal brain injury is the single greatest cause of disability over the whole of life. The team played a key role in developing brain cooling, now the first established therapy for injury after low oxygen levels at term. However, cooling is effective only in a limited window of time, and is unlikely to be suitable for extremely preterm infants. We have now shown that severe brain lesions can develop weeks after a period of low oxygen and that the lesions are preceded by local inflammation, raising the tantalizing possibility of effective late treatment. Using established fetal sheep models, we will evaluate promising anti-inflammatory and trophic interventions to prevent this late brain injury and to improve brain development after early treatments such as cooling. We will test new algorithms to predict the onset of late brain injury, to help clinicians target therapy to babies who may benefit from new treatments.