Hannah Norman-Bruce

Image

Young children frequently attend the emergency department (ED) with wheeze which is usually triggered by a virus infection, such as the common cold. Wheeze can be treated with inhaled medications and sometimes oral steroid medicines are also given to reduce swelling within the lungs. Unfortunately, oral steroids can have side effects. Despite lots of research there is no clear evidence that oral steroids work in young children with a wheeze attack. It is likely that some children get better quicker with oral steroids but deciding who to treat is difficult. This results in differences in care with some children receiving unnecessary oral steroids and others not receiving them when they could benefit.

We hypothesise that in a subgroup of children with mild-to-moderate acute wheeze attacks, the viral trigger can predict their response to steroid medications. Previously, respiratory virus testing was too slow to be used to inform treatments in the ED. Now, point-of-care (POC) viral tests can provide results within 30 minutes. There is a research gap regarding the role of these tests in determining steroid responsiveness and outcomes in children presenting with acute wheeze in the pre-school population.

In order to address our hypothesis in a future definitive trial we need to ascertain the feasibility of using (POC) viral tests to randomise steroid treatments for children in a clinical study in the ED setting.  The PRECISE Study will therefore be a single centre randomised, feasibility study enrolling approximately 60 pre-school aged children to inform a future definitive multi-centre Randomised Controlled Trial.

About me

I am an ST7 paediatric trainee in Northern Ireland. Cat lover and sea swimmer.  I started my training in Sussex but relocated to Northern Ireland two years ago, where it is harder to get in the sea all year round!

My research interests include wheezing disorders, paediatric infection and precision-based medicine.

Publications

• In press: The diagnostic test accuracy of procalcitonin and C-reactive protein for predicting invasive bacterial infections in young febrile infants. A systematic review and meta-analysis. To be published in: The Lancet Child & Adolescent Health, 2024
• Norman-Bruce H, Umana E, Mills C, et al. Systematic review and meta-analysis assessing the diagnostic test accuracy of procalcitonin in the diagnosis of invasive bacterial infections in febrile infants: a study protocol. BMJOpen 2022;12:e062473.
• Umana E, Mills C, Norman-Bruce H, et al Applying clinical decision aids for the assessment and management of febrile infants presenting to emergency care in the UK and Ireland: Febrile Infant Diagnostic Assessment and Outcome (FIDO) Study protocol BMJ Open 2023 doi: 10.1136/bmjopen-2023-075823
• Umana, Etimbuk; Norman-Bruce, Hannah; Mills, Clare; Mitchell, Hannah; McFetridge, Lisa; Waterfield, Thomas;  Febrile Infants Diagnostic Assessment and Outcome study group. Applying the American Academy of Pediatrics guideline to a cohort of febrile infants attending emergency departments in the UK and Ireland. European Journal of Emergency Medicine 30(3):p 219-221, June 2023. DOI: 10.1097/MEJ.0000000000001023
• Cathal Roarty, Clare Mills, Claire Tonry, Peter Cosgrove, Hannah Norman-Bruce, Helen Groves, Chris Watson, Tom Waterfield Study protocol: Medium throughput, deep proteomic characterization of children with PIMS-TS, and identification of candidate diagnostic biomarkers doi:10.1101/2022.12.27.22283890

Research Activity

Throughout my career, I have continued to identify knowledge gaps in clinical practice, deepening my desire to pursue an academic career. I am particularly passionate about the development of precision-based medicine in everyday clinical practice, aiming to move away from “one size fits all” approaches. In 2022, I completed an MSc in Experimental Medicine focusing on the diagnosis of bacterial infections in febrile infants.  I am excited to be embarking on a PhD to work towards a personalised medicine approach for pre-schoolers with wheeze. 

• ESPNIC 2023 Athens: Presentation and Poster SERVICE EVALUATION OF BIOFIRE POINT OF CARE TESTING FOR DIAGNOSIS OF RESPIRATORY INFECTIONS IN PICU Samir Waheed S,, Wilson K, Norman-Bruce, H.
• ESPNIC 2023 Athens: Presentation and poster Re-emergence of Respiratory Pathogens in a Regional Paediatric Intensive Care post COVID-19 Pandemic. K. Wilson, H. Norman-Bruce, S. Waheed, P. Flannagan, H. Groves, J. Richardson;
• ESPID 2023 Lisbon: THE DIAGNOSTIC TEST ACCURACY OF PCT AND CRP IN THE DETECTION OF BACTERIAL INFECTIONS IN FEBRILE INFANTS LESS THAN 90 DAYS OF AGE. A SYSTEMATIC REVIEW AND META-ANALYSIS. E-POSTER DISCUSSION SESSION 04: DIAGNOSTICS AND BIOMARKERS Hannah Norman-Bruce, Etimbuk Umana Clare Mills Hannah Mitchell  Lisa Mcfetridge David Mccleary Thomas Waterfield
• ESPID 2023 Lisbon: RISK OF INVASIVE BACTERIAL INFECTION (IBI) AND URINARY TRACT INFECTION (UTI) IN FEBRILE INFANTS 90 DAYS AND YOUNGER WITH CONCURRENT SARS-COV-2 (COVD19) INFECTION. E-POSTER DISCUSSION SESSION 07: COVID-19 Etimbuk Umana, Hannah Norman-Bruce, Clare Mills, Thomas Waterfield, Febrile Infants Diagnostic Assessment And Outcome Study Group