We are back with our series Bridging the Gap! For each post, we are interviewing women in neuroscience to discuss the gaps and the health inequalities relating to different areas of neuroscience, as well as the exciting new research that is attempting to bridge these gaps.
From the fast-paced neonatal intensive care unit to groundbreaking research on preterm birth and health equity, Dr. Katie Mckinnon is a clinician and researcher dedicated to improving outcomes for the most vulnerable infants. A Neonatal Registrar at St George’s Hospital in London, she balances frontline care with academic research, exploring the long-term effects of preterm birth and how socioeconomic factors shape neonatal neurodevelopment. In this interview, she shares her career journey, the challenges of working in neonatology, and how research and clinical practice go hand in hand to shape the future of neonatal care.
Please could you briefly summarise your career journey to end up in the position you are in now? What made you pursue these roles?
I studied medicine straight out of school, and although initially ruling out children (and particularly babies) as being far too scary to work with, my paediatric placement at Barnet Hospital made me realise that these were my people. After my foundation year placements, it was my Clinical Fellow post (FY3 year) in neonatology at University College London Hospital that convinced me that babies are magic, and that research is an important part of clinical work.
Neonatology is a fairly young speciality, developing in the second half of the 20th century. There have been huge advances in recent decades, in terms of the care of the smallest and most vulnerable infants, and the evolution of care from focussing on children surviving to children thriving. There is so much we still don’t know, and many of the guidelines we follow are based on evidence extrapolated from larger children or adults, or on expert consensus. The changing physiology of infants after birth, and throughout their stay with us in the neonatal unit, means we have to go back to basics in their care, and if we can use a good evidence base to make our clinical decisions for each child, we can give them the best chance going forward.
I started doing small research projects at that point, knowing my aim was to undertake a PhD. After a fair few failed attempts to find a PhD placement, a wonderful colleague and mentor, Dr Angela Huertas, sent me the application link for the role I ended up taking. I joined Professor James Boardman’s lab at the University of Edinburgh, working in the Theirworld Edinburgh Birth Cohort. I was able to focus on two areas I am particularly passionate about: neonatal neurodevelopment and health equity. My final thesis title was “Incomes and outcomes: Preterm birth, socioeconomic status, and neurodevelopment”. My post allowed me to continue my clinical work at the Royal Infirmary Edinburgh, working night shifts in the neonatal unit to keep up my skills, and working in research the rest of the time.
I have now been awarded my PhD, and I’m working on the next steps. I have returned to neonatal subspeciality training in London, currently working at St George’s Hospital in Tooting part-time. The rest of the time, I am working on a number of projects with various collaborators, still focusing on neonatal neurodevelopment and health equity. I am applying for research posts and grants to start establishing myself as an independent researcher.
What is your day-to-day (or week) schedule like?
Quite variable - neonatology is a busy, intensive care speciality, with rotating night/day shifts. When I’m in the unit, there is no time to think about my research work. However, at the end of a shift you can handover to someone else on the next shift, so when I’m not in the hospital, I try to focus on my other projects. At the moment, I’m spending a lot of time writing grant and job applications, but I also have a couple of projects coming to an end that I’m preparing for publication and conferences.
How do you juggle a PhD alongside being a neonatal subspeciality trainee?
It is a tricky balance between clinical life and research, but sometimes a change is as good as a break. I would love to keep both as part of my career going forward, because they are so beautifully interlinked that I really think they benefit each other. Spending time on the shop floor with babies and their families makes you think about what we don’t understand, and what we can try to improve. Working in research means you are able to learn about the latest developments to try and translate those into the best possible care for your patients.
The NHS constitution also includes commitments to research for patients, and within neonatology research-active units, they seem to have better outcomes for their infants. Being part of a research study, even if you are in the placebo arm, is beneficial for outcomes – the “trial effect”.
Across both clinical life and research life, I also aim to use my experience to translate new knowledge into practical changes to guidelines and care for infants. I am part of the British Association of Neonatal Neurodevelopmental Follow-Up (BANNFU), working on a new national guideline to establish four-year follow-up appointments for infants at risk of neurodevelopmental difficulties. This has been highlighted as an important time point for assessment and support for these children, just before they enter school. Unfortunately, only 7% of neonatal units across the UK have these clinics established. This project has involved working with clinicians, parents, teachers, allied health professionals, and psychologists, to make sure we are providing the most useful guidance to make it a worthwhile visit for all.
Your research interests include neonatal neurology, neuroimaging, and neurodevelopment. What gaps exist in the research of neonates? What are your thoughts on the outdated (and incorrect) view of babies as ‘small adults’? How can we close these gaps so that we can provide even better neonatal care?
There are so many things we don’t know, which is a bit terrifying but also exciting for the future. Looking back at the history of neonates, how research has changed what we do, and realising some of the things we thought were helping were actually doing harm…it does make me worry about what we are doing now, but it also pushes research forward. An example is oxygen and retinopathy of prematurity - we now know that high levels of oxygen can cause blindness for preterm infants, but low levels of oxygen increase mortality, and over the last 80 years there have been big swings in approaches as we have learnt more. We now titrate oxygen carefully from birth and throughout a baby’s stay in the neonatal unit and have regular screening by the ophthalmologists so we can intervene early if signs start to develop.
As you say, children are not small adults, and babies are not small children. The Academy of Medical Sciences recently released a statement highlighting the need for prioritisation of child health and research - focussing early intervention efforts here will help national health and prosperity. Many research studies exclude children and people who are pregnant or breastfeeding - how can we understand the impacts (positive or negative) of new treatments on infants if we don’t study them? The Covid pandemic highlighted these disparities – we now know that giving the Covid-19 vaccine during pregnancy is not only safe but reduces risks to the pregnant person and their baby. This vulnerable population was excluded from the first round of vaccine trials, delaying their protection. In fact, only one medicine has ever been developed especially for babies (surfactant), and 90% of medicines used in newborn populations have inadequate information on dose, safety, and efficacy.
The other challenge in neonatal research is the fact that some of the conditions we study are rare, and we need to adapt how you study them. I am currently involved in a study using the British Paediatric Surveillance Unit (BPSU), which allows national surveillance through paediatricians across the UK. This is examining children with no heartbeat detected at ten minutes after birth - looking at incidence, clinical features, initial management, and neonatal outcome (this work is being presented at the Neonatal Society Spring Meeting 2025). We found an incidence of 6 per 10 million live births, so it’s very rare. Using this unique resource to gather data means we have learnt that a significant proportion of these infants can still have a good neurological outcome, which may change how we manage the resuscitation of these infants after birth. Elsewhere, people are starting to develop platform trials for neonates, building on the wonderful National Neonatal Research Database within the UK, where every neonatal unit contributes routinely collected data. This opens up new avenues for feasible but large-scale trials.
How easy is it to perform MRI on foetuses and children - is the machine adapted?
Over the years, I have been involved in MRIs for foetuses, neonates, and children, both in clinical contexts and research. All have their challenges, particularly around motion. Partly, it is about preparing people well for the scan. For babies, we feed and wrap them and scan once they are asleep. Interestingly the babies born preterm often do better than the term infants at staying asleep in the scanner - perhaps because they are used to sleeping through alarms and the other noises of the neonatal unit, and the MRI is just another white noise. During my PhD, I scanned many five-year olds, who are very different. We used a booklet and animated video to talk through how it works and what to expect, and a mock scanner so they can practice lying still. Our scanner also allowed the children to watch a film or TV show during the scan, which is very helpful to keep them happy.
The machine itself isn’t really adapted for foetuses and children, apart from different coil sizes, but there are changes to the sequences and protocol. Other clever people have also optimised data processing pipelines for foetuses and infants to allow motion correction and so on.
How useful are long-term cohort studies for research into the effects of socioeconomic factors and preterm birth? How are they being used? Are there many cohort studies being carried out?
Long-term studies are crucial to investigate outcomes of early perinatal exposures, including preterm birth and socioeconomic deprivation, because these are both life-course conditions.
Currently many studies after preterm birth use short-term outcomes, such as imaging or neurodevelopmental assessments in the first two years of life. However, many outcomes can’t be identified until later, including neurodiversity, mental health conditions, complex education challenges, and some of the health issues, such as cardiovascular disease, and lung health.
The Theirworld Edinburgh Birth Cohort, alongside the new PRENCOG study (PREterm Neurodevelopment and COGnition), are ways this is trying to be addressed within Edinburgh, looking at the long-term outcomes after preterm birth, and how susceptibility and protective influences affect brain development.
The biggest studies into preterm birth in the UK were EPICure and EPICure2, which gave incredible insights into outcomes for the most preterm infants (born at 22-26 weeks of gestation). The first began thirty years ago, so has given us information about outcomes into adulthood, but with the immense changes in acute neonatal care since then, we need new cohorts to show what the outcomes are for the care we provide now.
There are other ways to look at these longer-term outcomes beyond cohorts, such as using the National Neonatal Research Database, or other routinely collected data. I’m hoping to use this approach in an upcoming project.
Following preterm birth, how are children and adults affected by this long-term?
Preterm birth is associated with an increased likelihood of a range of adverse outcomes (a nice review is available here), but many children born preterm survive and thrive. Identifying who is most at risk of adverse outcomes is key to intervening early to optimise their future. Many adverse outcomes increase in likelihood with the degree of prematurity - i.e. those born extremely preterm (at <28 weeks) are more at risk than those born very preterm (28-32 weeks), who are more at risk than those born late preterm (33-36 weeks). Other factors we know affect long-term outcomes are medical complexity and conditions, including significant brain bleeds or conditions like sepsis, bronchopulmonary dysplasia, and necrotising enterocolitis, but socioeconomic factors are also crucial to consider.
Preterm birth is associated with motor difficulties, such as cerebral palsy and developmental coordination disorder. They may have lower IQ, executive function, and language skills, and are more likely to have special educational needs, with lower educational outcomes. They have higher rates of social difficulties and inattention, although not all meet the diagnostic criteria for neurodiversities, such as autism and ADHD - these features have been labelled the “preterm behavioural phenotype”. In the longer term, they are more likely to have internalising mental health problems, and are less likely to form romantic partnerships or become a parent.
However, although preterm birth is a life-course condition, as I mentioned, adverse outcomes are not inevitable. Most preterm individuals are successful across education, work, and relationships. Even for those with difficulties, those born preterm report a good quality of life. As clinicians and researchers, we need to find ways to maximise the chances for preterm infants, so that they can reach their potential.
Socioeconomic factors play a role in many aspects of our life experience. How have they been found to impact preterm birth? What can we be doing to close this gap in experience and adequately represent all groups in our research?
There is an over-representation of socioeconomic deprivation in preterm infants and their families, with complex reasons for the higher rates of preterm birth that include, but cannot be fully explained by, smoking, nutrition, and access to antenatal care.
In term-born infants, socioeconomic deprivation is associated with physical and mental health and other outcomes across the lifespan. These impacts have been found to interact with preterm birth effects in various areas. For example, a previous study by Professor Boardman’s group found that the chance of speech, language and communication concerns at 30 months, for infants born at their due date from the most deprived neighbourhoods, was similar to infants born at 27 weeks of gestation from the least deprived neighbourhoods. For all birth gestations, the chance of concerns was higher for children from more deprived neighbourhoods. There are similar interactions for early childhood emotional, behavioural, and psychomotor outcomes.
My PhD research found that both preterm birth and socioeconomic deprivation are associated with differences in brain development in the neonatal period and at five years of age. This was using two different brain MRI metrics - regional volumes and fractional anisotropy. Socioeconomic status is multifactorial, and there are different ways of measuring it. I found that the most important socioeconomic status measure in relation to the brain changes as children get older - from family measures, such as maternal education, to neighbourhood measures, like the Scottish Index of Multiple Deprivation. There is time for interventions to reduce social disparities during the perinatal period, which could promote healthier brain growth after preterm birth. It may be that any interventions to support infants and their families need to change as children get older.
We know that research is not always representative of all groups, and we need to make a concerted effort to change that. Involving patients and families from all backgrounds in the development of studies early on is the first step in making that happen.
Having a preterm baby is stressful for many - with your research and experience, what words of advice or support would you give to parents?
No one thinks their baby will end up in the neonatal unit, but we are ready for them, and within the team everyone will be happy to answer any questions. Most units in the UK also have psychological support for families to help them deal with the unimaginable situation they find themselves in.
There are some incredible charities out there, including Bliss, for various specific conditions babies might have, and local neonatal units often have their own, which can also provide support for families.
You were nominated for (and won!) the WiNUK Rising Star of the Year Postgraduate Award at WiNUK Awards 2024 - congratulations! How did it make you feel to be nominated and to win?
“[Katie’s] PhD research has so far yielded three first-author peer-reviewed publications, four oral conference presentations, and two poster presentations, alongside first prize in the predoctoral plenary competition at the Clinical Academics in Training Annual Conference 2023, and best trainee presentation prize at the Neonatal Society Spring Meeting 2024. Findings have been reported in national press and an interview on STV News, reflecting the interest and impact of the research.
She has used her equality and neuroscience experience to develop national guidelines to improve developmental follow-up for preterm-born infants alongside teachers and parents. Her other patient and public involvement activities include delivering public talks and child-friendly brain-related activities at the Edinburgh Science Festival. “ Taken from Katie Mckinnon’s nomination statement.
Thank you again for the award! It was such an honour to receive this nomination from my PhD supervisor, Dr Hilary Richardson (we chatted to Hilary here), let alone to win - there were so many incredible researchers who were nominated.
WiNUK Rising Star of the Year Postgraduate Award was sponsored by the British Neuroscience Association.
This interview was conducted by Rebecca Pope and edited by Lauren Wallis, with graphics produced by Lilly Green. If you enjoyed this article, be the first to be notified about new posts by signing up to become a WiNUK member (top right of this page)! Interested in writing for WiNUK yourself? Contact us through the blog page and the editors will be in touch.
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