My current research is in three main areas:

• Antenatal lung growth
  Impaired antenatal lung growth is a common outcome, pulmonary hypoplasia being found in 15-20% of early neonatal deaths. Reference ranges of normal lung growth have been established, mechanisms have been elucidated and interventions evaluated in various conditions associated with abnormal growth. We have investigated the role of diaphragmatic function in abnormal lung growth, particularly in infants with surgically correctable lung anomalies and developed novel tests of diaphragmatic function in neonates. We are currently evaluating the predictive value of new antenatal assessments with regard to chronic respiratory morbidity.
• Prevention of chronic respiratory morbidity following premature birth
  Chronic oxygen dependency and associated respiratory morbidity is unfortunately common following very premature birth. Factors important in the development of chronic oxygen dependency have been identified and prophylactic and treatment therapies examined, this has involved the development and evaluation of new techniques of respiratory support. Predictors of chronic lung disease have been assessed in order that prophylactic treatments can be most effectively targeted. Respiratory syncytial virus infection is associated with an increased risk of asthma in childhood in previously healthy infants and prematurely born infants suffer more severe acute RSV infection. Currently, the importance of initial airway size and genetic predisposition in determining the long term respiratory outcome in prematurely born infants who develop RSV infection is being assessed. Prematurely born infants are at increased risk of sudden infant death syndrome. As a consequence, the effect of posture and antenatal smoking exposure on respiratory control and function is being examined.
• Effect of chronic disorders on respiratory function in children
  Vital to diagnosis and appropriate treatment of respiratory morbidity is quantification of any abnormality, hence an important area of research has been the development of appropriate lung function tests for all ages, even those receiving intensive care. These tests have been used to facilitate management of young children with asthma and determine the impact of liver disease on pulmonary function. Two cohorts of children with sickle cell disease in South London and Jamaica are being followed. The prevalence of lung function abnormalities in these populations has been determined and ethnically appropriate reference ranges have been established. The role of asthma/reactive airway disease in the development of the acute and chronic respiratory complications in SCD have been determined and the efficacy of prophylactic anti-asthma agents is currently being explored.

Neonatology; respiratory physiology; antenatal lung growth; paediatric chronic lung disease