Professor Nikki Robertson (MB ChB, FRCPCH, PhD)

Professor of Perinatal Neuroscience & Honorary Consultant Neonatologist

  • Centre for Clinical Brain Sciences
  • The Roslin Institute

Contact details

Address

Street

The Roslin Institute

Midlothian EH25 9RG

City
The University of Edinburgh, Easter Bush Campus, Midlothian
Post code
EH25 9RG
Street

Centre for Clinical Brain Sciences,
Chancellor's Building,

City
Edinburgh BioQuarter, 47 Little France Crescent,
Post code
EH16 4TJ

Background

Professor Nikki Robertson trained in neonatal medicine in Melbourne and London after completing her medical training at the University of Edinburgh. Her interest in perinatal brain injury was kindled at the Hammersmith Hospital, Imperial College London in the late 1990s, a time of exponential increase in our understanding of the evolution of brain injury after birth asphyxia. Using MRI and MRS, the timing and evolution of brain injury in babies with neonatal encephalopathy (NE) could be followed, leading to the seminal finding that therapetuic hypothermia (HT) ameliorates the secondary wave of energy failure.  HT is now standard care in babies with NE, however, not all babies benefit. Since 2003 at UCL, Professor Robertson has used pre-clinical models to assess the safety and efficacy of additional  therapies that  can complement and synergize with HT, eg melatonin and human umbilical mesenchymal stem cells. In 2020, Professor Robertson joined the University of Edinburgh as Professor in Perinatal Neuroscience and Honorary Consultant Neonatologist. 

 

CV

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Qualifications

MB ChB     University of Edinburgh                                                                 1983-1988

PhD            University of London                                                                        2002

Fellow of the Royal College of Pediatrics and Child Health                 1995

Responsibilities & affiliations

University College London

Open to PhD supervision enquiries?

Yes

Current PhD students supervised

PhD

Dr Kathryn Martinello    2018-2021     Inflammation-sensitized Brain Injury

Dr Raymand Pang            2019-2024    Repurposing Azithromycin as a Neuroprotective Therapy for NE

Past PhD students supervised

2003-2005 (completed)    MD  Primary supervisor    Jeanie Cheong     4.7 Tesla MRI and MRS of NE

2005-2009 (completed)    PhD Primary Supervisor    Divyen Shah    aEEG Reflects Cerebral Injury in the Newborn

2007-2010 (completed)    PhD Second Supervisor    Sudhin Thayyil    Minimally Invasive Autopsy

2007-2012 (completed)    PhD Primary Supervisor    Cornelia Hagmann    Qualitative and quantitative MR imaging in preterm infants: relation to neurodevelopmental outcome

2006-2011 (completed)    MD  Primary Supervisor    Manigandan Chandrasekaran    Cerebral MRS Biomarkers and Outcome in Perinatal Asphyxia

2010-2013 (completed)    PhD Second Supervisor    Gemma Williams    Mapping Pain and Nociception in the Infant Brain

2007-2013 (completed)    PhD Primary Supervisor    Sachiko Iwata    Safe and effective cooling using phase changing material

2007-2014 (completed)    PhD Primary Supervisor    Osuke Iwata    Cerebral phosphocreatine overshoot after perinatal HI

2012-2014 (completed)    PhD Second Supervisor    Tharindi Hapuarachchi    UCL CoMPLEX

2010-2013 (completed)    PhD Primary Supervisor    Alan Horn (University of Cape Town)    Relation between aEEG and NE score

2010-2015 (completed)    PhD  Primary Supervisor    Cally Tann (Wellcome     Perinatal risk factors for NE in Uganda

2009-2017 (completed)    PhD  Primary Supervisor    Mojgan Ezzati    Ischaemic post conditioning as a neurpprotective therapy after perinatal HI

2014-2018 (completed)    PhD Primary Supervisor    Subha Mitra    Near Infrared Spectroscopy biomarkers in NE

2015-2020 (completed)     PhD  Primary supervisor     Ingran Lingam. Magnesium as a neuroprotective agent with cooling 

Research summary

My clinical and research interest is neonatal brain injury and neuroprotection of the term and near-term baby, working both as a consultant neonatologist and research group lead at UCL over the past 20 years. The journey has been exciting and fast-moving, with therapeutic hypothermia (HT) for neonatal encephalopathy (NE) being a significant advance in newborn care. However, as HT is only partially protective, we are searching for adjunct therapies which can complement and synergize with HT.  We study mechanisms of brain injury using MR techniques and NIRS. With the aim to move therapies along the translational pipeline, we have studied the following neuroprotective agents: melatonin, noble gases (xenon and argon), amiloride, erythropoeitin, remote ischemic post conditioning.  We have shown that proton MRS is a robust marker of neurodevelopmental outcome in NE and we use this biomarker both in our pre-clinical models and for clinical prognosis.

Current research interests

In October 2020, I was appointed as Professor of Perinatal Neuroscience at the University of Edinburgh and Honorary Consultant Neonatologist at the Royal Infimary of Edinburgh, returning to my Alma Mater after 30 years. The world-class laboratory facilities at the Roslin Institute and LARIF will facilitate the translation of therapies from bench to bedside and I am excited to have the opportunity to study human umbilical mesenchymal stem cells (huMSC) as a potential powerful neuroprotective therapy  at the University of Edinburgh, funded by the MRC.  I am committed to the delivery of optimal clinical neurocritical care as part of a neuroprotective bundle. In the next 5-10 years I am keen to set up and inspire clinical trials of the most promising adjunct therapies with HT, the development of biomarkers to assess inflammation sensitization, tailoring neuroprotection to specific babies. Our pre-clinical studies have shown that melatonin at therapeutic levels, given soon after injury, is a safe and effective therapeutic agent and early phase clinical trials are urgently needed. 

Past research interests

My interest in neuroprotection extends to low resource settings in particular sub-Saharan Africa. As inflammation-sensization is known to exacerbate injury, we have developed a model of LPS-sensitized hypoxia-ischemia, working with the Bill and Melinda Gates Foundation on therapies relevant to low resource settings (such the antibiotic Azithromycin, repurposed as a neuroprotective agent, acting by  immunomodulation).  In Uganda, our studies led to an important understanding of risk factors for NE and possible concerns of HT in this setting. As the main burden of NE is in low resource settings, my aim is to ensure we develop economical, practical, safe neuroprotective interventions relevant to both high and low resource settings.

Knowledge exchange

Optimizing therapeutic hypothermia for babies with moderate to severe neonatal encephalopathy 

Novel melatonin formulation (collaboration with Chiesi Pharmaceuticals) Int. pat. appl. PCT/EP2018/056423; https://patentscope.wipo.int/search/en/detail.jsf?docId=WO2018167162

Lac/NAA validation as a surrogate outcome marker for babies with NE

 

Project activity

INSTINCT Study: Intranasal Stem Cells for Improving Neurodevelopmental Outcomes in Neonatal Encephalopathy

Our primary aim is to assess neuroprotective effects of intranasal (IN) human umbilical cord stem cells (huMSC; clinical grade, manufactured at UCL) in a neonatal model with and without therapeutic hypothermia  using aEEG, MRS and neurodevelopment as safety and outcome measures prior to early phase clinical trials. 

The use of stem cells to successfully treat neonatal brain injury is emerging as a promising therapy. Human umbilical cord mesenchymal stem cells (huMSC) self renew and stimulate host brain cells to regenerate and repair, with superior anti-inflammatory properties than MSC from adult tissues. Importantly, although huMSC do not survive long term and replace damaged tissues themselves, they react to the needs of the ischemic cerebral environment by secretion of growth factors, cytokines and extracellular vesicles (EVs)  to regulate damage and repair. These intrinsic adaptive properties of huMSC make them excellent candidates to treat the devastating effects of NE. The newborn brain is still in a developmentally active phase, leading to high efficiency of huMSC.

 

Current project grants

1. MRC UK
INSTINCT Study: Intranasal Stem Cells for Improving Neurodevelopmental Outcomes in Neonatal Encephalopathy. 2021-2024.
PI: Professor Nicola Robertson
Co-applicants: Professor Mark Lowdell, Dr Daniel Fullen, Professor Xavier Golay, Professor Boris Kramer

2. Bill and Melinda Gates Foundation. 2019-2022
PAINT: Piglet Asphyxia Inflammation Model for Neonatal Therapies
PI: Professor Nicola Robertson

3. Wellbeing of Women. 2020-2022
CAMELLIA Study: Cooling and Melatonin in LPS- sensitised Asphyxia
PI: Professor Nicola Robertson

Past project grants

Grants held over the last 5 years
Total Grant Funding ~£20 million
Grant Funding as Principal Investigator ~£16 million

1. MRC UK. 2018-2021. Development of a cot-side optical biomarker of brain tissue health following neonatal hypoxic-ischaemic brain injury. Co-applicant

2. MRC UK. 2017-2019 EMPATHY Study. Epo and Melatonin for Perinatal Asphyxia with Therapeutic Hypothermia PI.

3. Saving Lives at Birth. 2017-2020 RS-17-08196: Smart sclera screening of jaundiced newborns in Ghana. Co-applicant

4. MRC UK. 2015-2017. Reducing the Burden of Neonatal Brain Injury: Assessment of Hypothermic & Melatonin Neuroprotection in an Inflammation-Sensitised Piglet Asphyxia Model. PI

5. Action Medical Research. 2015-2017. Refining the potential use of magnesium in neonatal encephalopathy: safety, pharmacokinetics and neuroprotection of magnesium-augmented hypothermia compared to hypothermia alone. PI

6. Chiesi Farmaceutici S.p.A. 2014-2016. Melatonin for Birth Asphyxia (MELBA): optimizing dose and therapeutic window. PI

View all 153 publications on Research Explorer

Invited speaker

April 9-12, 2018, 99nicu Meetup - advancing the management of newborns” Vienna, Austria. Precision Medicine in NE – is this possible?

June 7-9 2018 , Rostock, Germany, The Society of Neonatology and Pediatric Intensive Care (Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin GNPI) Neonatal Encephalopathy with special focus on current therapy concepts but also on future concepts from xenon to ischemic postconditioning. 

June 11-13 2018,  Neonatal conference Buenos Aires, 4 lectures: 1. Prognosis using MRI and MRS in Neonatal Encephalopathy; 2. Neonatal Seizures; 3. New Treatments for Neonatal Encephalopathy; 4. Therapeutic hypothermia: the journey over the last few decades

October 15-18 2018, Bill Gates Foundation. Grand Challenges Annual Meeting 2018: Berlin Germany, Invited speaker for Birth Asphyxia Consortium. Hypoxic Injury and Neonatal infection: do current treatments address this common combination?

November 22-24 2018, Cool topics in Neonatology, 2018, Melbourne, Australia. Invited Talks 1. Inflammation Sensitized Brain Injury: how do we detect and treat it? 2. Melatonin the Healing Hormone- is it ready for prime time? 3. Neonatal Seizures – an update from high and low resource settings

November 23-25, 2018. The Neonate, 2nd International Symposium for Asia -Shanghai, November 23-25, 2018. 1. Novel Therapies for Neonatal Encephalopathy; 2. Neuroprotective Bundle of Care for Preterm Babies

February 20-21, 2019. Bill Gates Birth Asphyxia Consortium, Seattle, USA

March 20-22, 2019 , Perinatal Asphyxia meeting, Modena (Italy), organized by Mariani Foundation. MR Spectroscopy Biomarkers

March 28-30, 2019, 7th International Meeting - from Fetal Life to Childhood maternal-infant nutrition congress, Istanbul, Turkey. Invited Talks. 1. New modalities in Neuroprotection; 2. Magnetic resonance biomarkers of neonatal brain injury

April 4th-6th, 2019. 2nd World Congress Maternal Fetal Neonatal Medicine, London. Term NE – how can we augment protection from therapeutic hypothermia?

April 15th-17th 2019.   Ipokrates Clinical Seminar, Doha Qatar, Neonatal Pharmacology. 1. Neonatal Seizure Treatments – the new, the old and the useless; 2. Potential New Adjunct Therapies to Avoid Adverse Neurodevelopmental Outcome in Neonatal Encephalopathy

May 23 – 25, 2019 IPOKRATES Clinical Seminar. Protecting and Developing the Brain. Kagawa International Conference Hall, Takamatsu City, Kagawa, Japan. 1. MRI/MRS of the Neonatal Brain 2. Adjunct Therapies to include those for HIC and LMIC

17-21 September 2019 3rd Joint European Neonatal Society, Maastricht. Invited speaker. Pre-congress Course 3 – Basic Neuroscience Research Methods: Bringing Neuroscience into the Clinic. Parallel session: Translating neuroscience into clinical practice in low and mid income countries

24th September 2019 Neonatal and Children’s Brain Consortium Ireland, Dublin. Invited talk: Neuroprotection for Neonatal Encephalopathy – the old, the new and the unexpected.

4-5th October 2019. Sidra’s Inaugural Pediatric Neuroscience Conference, Doha, Qatar. Invited Talk: Neonatal Seizures – update on new treatments.

28th-31st  October 2019. Qatar Critical Care Conference 2019, NEW Developments in the Care of the Newborn with HIE

23-26 November 2019. CUDOS-2019, Doha, Qatar, Invited Talk: Neonatal Hypoglycemia and Brain Injury

10-13 November 2019. 43rd “Miami Neonatology Conference”, Loews Hotel in Miami Beach. Invited Talks. 1. Brain protection therapies applicable to low resource settings; 2. The heart rules the brain – The impact of congenital heart disease on brain development and injury in the neonatal period

February 26-28th, 2020. International Neonatology Symposium: Bangkok 2020. Invited speaker: 1.Tailoring Brain Protection to Low Resource Settings; 2. Therapies for Neonatal Encephalopathy. What’s Next?

April 1-5, 2020. 28th National Neonatology Congress, Turkish Neonatal Society, Antalya, Turkey. 1. Therapies for NE: what’s next? 2. Predicting outcome and Imaging Markers in NE

June 20-24, 2020. Conference on Neonatology, Avignon, France, Invited talk

8-10 September, 2020. Best of IPOKRATES, Munich Germany. Invited talk and workshop: Pathway of investigation and management of NE

September 17-19, 2020. 12th International Newborn Brain Conference , Carton House, Kildare, Ireland. Invited talk: Is it time for MRS to enter clinical practice?