I-CAN-development

Infant and Child Assessment of Neuro-development

Comprehensive neurodevelopmental assessment and follow-up for infants and children

Dr Frances O'Brien

Dr O'Brien has a long-standing interest in neonatal neurodevelopmental follow-up; she was privileged to learn neurological and developmental assessment techniques from one of the founders of neonatal follow-up at University College London Hospital over 25 years ago and has maintained this interest throughout her career.

She works as a Consultant Neonatologist at the John Radcliffe Hospital, Oxford where she developed and continues to lead the neurodevelopmental follow-up service for high-risk infants and young children (including babies born preterm).

Having undertaken a period of research investigating neurodevelopmental outcomes of prematurity in childhood and adolescence, she continues to have a research interest and is a co-investigator for the EveryPrem Project. She is an Honorary Senior Lecturer at the University of Oxford and supervises a PhD student evaluating a standardised neurodevelopmental screening tool for all children born preterm.

Dr O'Brien is the President of the British Association for Neonatal Neurodevelopmental Follow-up.

What is a Neonatologist?

A Paediatrician and specialist in newborn babies

A neonatologist is a doctor who specialises in the immediate and ongoing care of newborn babies. Becoming a Neonatologist requires doctors to complete paediatric training, becoming proficient with managing babies and children with a wide variety of conditions before specialising in the care of critically ill newborn babies. Neonatologists treat sick and preterm babies in the neonatal intensive care unit (NICU), and are also responsible for the care of well term-born babies on the postnatal ward. Outpatient work involves medical and neurodevelopmental follow-up of babies and children to 2 - 3 years of age.

Education and experience

Frances studied at the London Hospital Medical College, University of London, gaining a First Class honours degree in Physiology before obtaining her MB BS and qualifying as a doctor in 1993. After house jobs she worked for in Obstetrics and Gynaecology, obtaining her DRCOG (Diploma of the Royal College of Obstetricians and Gynaecologists) before commencing Paediatric training in East London. She worked at the Royal London Hospital, the Homerton Hospital, Queen Elizabeth’s Hospital for Children and with the Hackney Child Development team in East London (1994-1996) gaining her MRCP (Member of Royal College of Physicians, London) in Paediatrics.

Frances undertook a period of research (1997-2001) and was awarded an Action Research Fellowship in Neonatology at University College London investigating the mechanisms and prevention of perinatal brain injury. She also investigated the neurodevelopmental outcomes of children born preterm, performing developmental assessments at 1, 4, 8 and 15 years of age on children who had been born preterm. As a Clinical Research Fellow her clinical role included the neurodevelopmental assessments of all infants born weighing <1000g at University College Hospital.

On completion of her research Frances returned to clinical medicine and Higher Specialist Training (HST) in Paediatrics in the North London Deanery, training in General Paediatrics, Neonatology and Community Paediatrics including neurodisability, in Camden & Islington. During this time her son was born preterm at 31 weeks and she found herself on the receiving end of neurodevelopmental follow-up care. Frances learnt a lot looking after a young child with neurological impairment and speech delay; colleagues in physiotherapy and speech & language therapy were a fountain of knowledge and were (and remain) highly valued.

Frances commenced HST in Neonatology ranking first in national interviews and elected to train at University College London Hospital (UCLH) and The Royal London Hospital where she honed her skills as a Neonatologist, and in 2008 obtained her Certificate of Completion of Specialist Training.

Locum Consultant positions at UCLH and Luton & Dunstable Hospital preceded the family move out of London when Frances was appointed as a consultant at The John Radcliffe Hospital in Oxford; she has worked for Oxford University Hospitals NHS Foundation Trust since 2009.

In addition to clinical duties as a Consultant Neonatologist, Frances has various roles such as Lead for Postnatal, Low Dependency and Transitional Care, Educational Supervisor and Clinical Supervisor for neonatal and paediatric trainees, course director for Cranial Ultrasound courses and holds medical lead positions for neonatal perioperative care, UNICEF Baby Friendly Initiative, Family Integrated Care, the Home Tube Feeding Programme and Developmental Care. She also developed and continues to lead the 2-year neurodevelopmental follow-up programme for Oxfordshire babies. She has been awarded Clinical Excellence Awards for delivering these initiatives.

Frances has retained her academic and research interest and been involved with numerous clinical research studies over time as well as teaching and assessing medical students. She is an Honorary Senior Clinical Lecturer in Paediatrics at the University of Oxford.

For further details about research see below

British Association of Neonatal Neurodevelopmental Follow-Up

Frances has been a member of BANNFU since it was founded. She co-chaired the BANNFU education and training sub-committee, organising successful annual neurodevelopmental follow-up study days and contributing to webinars for health professionals and parents.

She enjoys working with BANNFU members, sharing ideas, exchanging opinions and striving to improve national follow-up practices and outcomes. She promotes BANNFU’s ethos to work with parents and ex-preterms to ensure that the organisation's aims are relevant to them. She believes it is important that information about longer term outcomes (including education challenges, neurodiversity and mental health outcomes) is available and that relevant professionals in health and education services are well-informed.

Learn more about BANNFU

Qualifications and memberships

Qualifications

BSc (Hons) Physiology, First class        1990
MB BS                                                           1993
DRCOG                                                    1995
MRCP(UK) Paediatrics                        1996 CCST Paediatrics (Subspeciality Neonatology) 2008
GM Trust Certification (Advanced) 2020

Professional membership

Royal College of Paediatrics and Child Health
British Association for Neonatal Neurodevelopmental Follow-Up (President, Co-chair Education & Training)
Neonatal Society
British Association of Perinatal Medicine
Neonatal Perioperative Interest Group UK&I (founder)
Hospital Consultants and Specialists Association
Medical Protection Society

Neurology and neurodevelopment training

Amiel-Tisson assessment 1997
Prechtl General Movements, RFH, London 2004
Bayley Scales of Infant Development, UCL & RFH, London 2005
Griffiths Developmental Assessment Course, Harrow 2007
Prechtl General Movements, Advanced, UCLH, London 2020

Mandatory registration / certification

GMC reference no: 4046242
Registered with a licence to practice; on the Specialist Register: Paediatrics (Neonatal Medicine)

RCPCH Level III Safeguarding

Philosophy

Frances believes that newborns at risk of neurodevelopmental sequelae, whether from prematurity or illness, should have access to good quality developmental surveillance, and that impairments should be detected in a timely manner to enable early intervention with the aim of optimising neurodevelopmental outcome. Children not displaying classical neurological signs are still vulnerable to problems later in childhood, particularly behavioural, attention, and intellectual; detecting those at risk in infancy by detailed assessment during the crucial first 1000 days facilitates implementation of interventions designed to optimise outcome.

Doctors and other healthcare providers should be highly knowledgable and appropriately trained and their practice should be evidence-based. They should provide the highest quality of care, communicate effectively with their patients and their families, be culturally sensitive and emotionally supportive. Parents have a right to receive information and advice regarding developmental needs.

Professionals should facilitate and promote parent and caregiver relationships that are sensitive to an infant's status and responsive to their needs as these relationships are critical to optimal infant development.

Personal experience

As the mother of a very preterm baby, who is now an adult, Frances has experienced neonatology and neurodevelopmental follow-up as both service provider and user, giving her unique insight into the challenges faced by all involved.

Patient and Family-Centered Care

The level of family integrated care in neonatology is unparalleled, and neonatologists understand the holistic nature of care required to build a good rapport with families. Frances continues this beyond discharge from the NICU and aims to provide a holistic approach to follow-up and assessment, providing information and advice for families about their children's neurodevelopment progress. When healthcare providers and families work together, with mutual respect, trust and understanding, positive outcomes are achieved - optimal development of the child and wellbeing of the entire family.

Research and Publications

Dr O'Brien has research interests in neonatal neurology and neuroprotection, feeding and neurodevelopmental follow-up; she undertook a period of dedicated research 1997-2001 investigating the mechanisms and prevention of perinatal brain injury. She is currently supervising two PhD students undertaking research in the areas of neurodevelopmental follow-up and breastmilk expression for preterm babies (EveryPrem Study and Express Study)

Selected publications: Neurology, neurodevelopmental assessment and outcome

Tidswell AT, O’Brien F, Boland M and Holder DS. (1998) A retrospective analysis to determine if neonatal seizures are only eloquent if over the motor cortex; a possible explanation of electroclinical dissociation. (Abs) Presentation to British Society of Clinical Neurophysiology.

Cady E, Wylezinska M, Brooks K, Sakata Y, Nguyen Q, Thornton J, O'Brien F, Noone M, Sellwood M, Clemence M, Ordidge R, and Wyatt J. (2000) Very early cerebral lactate: A predictor of secondary energy failure? Child’s Nervous System 16:58-59

O’Brien F., Roth S., Stewart A., Rifkin L., Rushe T., Townsend J., Wyatt J. (2001) Neurodevelopmental progress into adolescence of very preterm infants. (Abs) Ped Res 49 (2):264 Oral Presentation at the 41st Annual Meeting of European Society for Pediatric Research, September 2000, Rhodes, Greece.

Mooncey S., Noone M., O’Brien F., Lawn C., Shaw J., Roth S., Townsend J., Stewart A. Wyatt J. (2001) High frequency oscillatory ventilation: survival and 1 year outcome. (Abs) Ped Res 49 (2):290

O’Brien F, Thornton J, Sakata Y, Shanmugalingam S, Bainbridge A, Priest A, Ordidge R, Roth S, Wyatt J. Cerebral T2 relaxation times in encephalopathic infants. Oral presentation at the 43rd Annual Meeting of European Society of Paediatric Research, August 2002, Utrecht, Netherlands.

Shanmugalingam S, Thornton J, Cady E, O’Brien F, Bainbridge A, Priest A, Ordidge R, Wyatt J. Early 1H Spectroscopy and Brain Water T2 in Encephalopathic Infants. Oral presentation at the 44th Annual Meeting of European Society for Paediatric Research, September 2003, Bilbao, Spain.

O’Brien F., Roth S., Stewart A., Rifkin L., Rushe T., Wyatt J. (2004) The neurodevelopmental progress of infants less than 33 weeks into adolescence. Arch Dis Child. 2004 Mar;89(3):207-11.

Vollmer B, Roth S, Riley K, O'Brien F, Baudin J, De Haan M, Vargha Khadem F, Neville BG, Wyatt JS. (2006) Long-term neurodevelopmental outcome of preterm children with unilateral cerebral lesions diagnosed by neonatal ultrasound. Early Hum Dev. 2006 Oct;82(10):655-61.

Shanmugalingam S, Thornton JS, Iwata O, Bainbridge A, O'Brien FE, Priest AN, Ordidge RJ, Cady EB, Wyatt JS, Robertson NJ. (2006) Comparative prognostic utilities of early quantitative magnetic resonance imaging spin-spin relaxometry and proton magnetic resonance spectroscopy in neonatal encephalopathy. Pediatrics. 2006 Oct;118(4):1467-77.

Gonzalez-Gomez, N, O'Brien, F, Harris, M. The effects of prematurity and socioeconomic deprivation on early speech perception: A story of two different delays. Dev Sci. 2021; 24:e13020. https://doi.org/10.1111/desc.13020

Agyeman-Duah J, Kennedy S, O'Brien F and Natalucci G. Interventions to improve neurodevelopmental outcomes of children born moderate to late preterm: a systematic review protocol [version 2; peer review: 2 approved]. Gates Open Res 2021, 5:78 (https://doi.org/10.12688/gatesopenres.13246.2)

Josephine Agyeman-Duah, Stephen Kennedy, Frances O’Brien Parental views on neurodevelopmental follow-up of children born preterm. Archives of Disease in Childhood Oct 2021, 106 (Suppl 1) A453-A454; DOI: 10.1136/archdischild-2021-rcpch.789

Selected publications: Feeding

Levene I, O’Brien F. Fifteen-minute consultation: Breastfeeding in the first 2 weeks of life - a hospital perspective. Archives of Disease in Childhood - Education and Practice Published Online First: 30 May 2018. doi: 10.1136/archdischild-2017-314633

Levene IR, Denton G, O’Brien F Expressing breast milk within 2 hours of preterm delivery is associated with adequate long-term yield of expressed breast milk. Poster presentation at 24th Reason Neonatal Meeting, 2018 University of Warwick

Levene IR, Denton G, O’Brien F What breastmilk expression volume targets are required for mothers of preterm babies? Poster presentation at 2018 UNICEF BFI Annual Meeting, Liverpool

Katherine Wood, Frances O’Brien, Karen Liddle, Rhys Dore. A neonatal short-term home nasogastric tube feeding programme. Infant 2020;16(2)

Park EHG, O'Brien F, Seabrook F, Hirst JE. Safe threshold of capillary blood glucose for predicting early future neonatal hypoglycaemia in babies born to mothers with gestational diabetes mellitus, an observational, retrospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):499. Published 2021 Jul 9. doi:10.1186/s12884-021-03973-5

Levene, I., Bell, J.L., Cole, C. Stanbury, K, O’Brien, F, Fewtrell, M, Quigley, M.A. Comparing the effect of a lactation-specific relaxation and visualisation intervention versus standard care on lactation and mental health outcomes in mothers of very premature infants (the EXPRESS trial): study protocol for a multi-centre, unmasked, randomised, parallel-group trial. Trials 23, 611 (2022). https://doi.org/10.1186/s13063-022-06570-9

Levene I, Alderdice F, McCleverty B, O'Brien F, Fewtrell M, Quigley MA. A report on parent involvement in planning a randomised controlled trial in neonatology and lactation - insights for current and future research. Int Breastfeed J. 2022 Sep 14;17(1):69. doi: 10.1186/s13006-022-00509-1. PMID: 36104819; PMCID: PMC9472727.