Dr Kevin Goss is a Consultant Neonatologist at University Hospital Southampton and part of the Research Leaders Programme (RLP).

His research focuses on understanding and improving the lung health of very premature babies.

He is also an Honorary Senior Clinical Lecturer at the University of Southampton.

Unprepared for their first breath

In the womb, babies’ lungs are filled with amniotic fluid. It’s only when they are born that they need to take their first breath, filling their lungs with air.

“This is one of the massive transitions that babies have to do,” says Kevin. “We’ve all had to do it – moving from the womb and not needing to breathe, to needing to breathe and have lungs that work.”

To prepare for this, a baby’s lungs will usually start to produce a natural secretion during birth called a surfactant. This spreads across the inner surface of their lungs during their first breath.

There are many different types of surfactant, including artificial ones. They all have similar properties.

“Washing up liquid is a surfactant,” Kevin explains. “If you put a drop of washing up liquid on water, it spreads itself as thinly as possible across the surface, or the water-air interface.

“That’s what surfactants do. They are molecules that want to line themselves up as thinly as possible across an interface.”

Natural surfactant is essential for the lungs to work properly. It lines the wet inner surface, and reduces the surface tension. This allows the lungs’ tiny air sacs, where oxygen enters the blood and carbon dioxide is released, to stay inflated.

However, very premature babies, born between weeks 22 and 28 of pregnancy (12 to 18 weeks early), are not able to make their own surfactant. This makes it much harder for them to breathe.

“These babies’ lungs are small and not very well developed,” explains Kevin. “It’s difficult for them to open, because the surface tension’s quite high. And at the end of a breath, when you take that pressure away, they collapse down again.”

These babies need to be given surfactant as a treatment. If they do not get enough, they can develop neonatal distress syndrome. This means they are more likely to need a ventilator to help them breathe. They can also develop longer-term problems with their lungs.

Investigating nutrition as a solution

Kevin did his PhD in Southampton, working with Professors Tony Postle and Howard Clark, and stayed on as a clinical lecturer. He left for a while, but returned six years ago as a consultant.

During his PhD, he worked with babies in the neonatal intensive care unit, investigating how they make surfactant. He gave them a labelled nutrient, allowing him to track the metabolic pathways it was used in.

Kevin showed the nutrient was used in metabolic pathways involved in the production of surfactant. He also showed that these pathways were less active in very premature babies, resulting in it taking them much longer to produce their own surfactant.

“The nutrient we’re talking about is choline, which is a really common essential nutrient that you find in lots of dietary sources,” he explains.

“It’s a really important molecule, because it’s a building block for not just surfactant molecules, but also molecules that help in neural signalling and brain development.”

Now, Kevin aims to use his RLP award to build on this research. He plans to further investigate choline metabolism in very premature babies, to understand the process in more detail.

In the longer term, he intends to run a trial to see if supplementing these babies’ diets with extra choline helps them to make more of their own surfactant and improves their health. During his RLP award, he will undertake the preliminary work required to apply for a grant to support this.

“We’re aiming to improve these babies’ outcomes by adjusting the nutrition they get,” he says, “to give them more of the building blocks they need to make their own surfactant.”

To do this, he will work closely with Professor Mike Grocott, as well as RLP award holders Dr Ahilanandan Dushianthan and Professor Mark Johnson, to develop a research group.

“What I want to do is to build a research group, with neonatal medicine an important part of our child health research,” he says. “This will allow it to become an ongoing area of research, a cornerstone of what we do in Southampton.”