Research at Monash Newborn
Monash Children's Monash Newborn is the largest neonatal intensive care unit in Victoria and with the support of tertiary paediatric services is able to care for a comprehensive range of medical and surgical problems in the newborn. Its clinical service is complemented by an active program of basic and translational research and a long standing collaboration with the Ritchie Centre of Baby Health Research (RCBHR) in the Monash Institute of Medical Research.
Research activities
Advanced respiratory care
This program has developed novel techniques for assessing lung inflation and airway patency by measuring the transmission of pressure oscillations, including audible sound, through the lung.
Lung development and inflammation
This program is seeking to find new treatment approaches for neonatal lung disease by investigating inflammation in the lung of newborn babies and testing potential therapeutics in animal experiments.
Brain blood flow and oxygen consumption
This program is applying a novel, non invasive technique using near infrared beams to acquire information about how to monitor blood and oxygen supply to babies’ brains. Prediction of outcome after perinatal asphyxia using MRI/MRS and two channel EEG This program uses several modes of bedside monitor and investigation to develop early predictor of outcome in babies who suffered lack of oxygen at time of delivery.
Point of care echocardiography
This program applies ultrasound investigations of the baby’s heart at the bedside to direct the use of drugs affecting blood pressure and heart rate more effectively.
Highlights
Guests
Monash Newborn and the RCBHR invited Claudia and Marcel Nold from the University of Colorado, Denver, USA who gave seminars on novel aspects of cytokine biology and its relation to neonatal inflammation. Claudia and Marcel will be joining the Monash Newborn and RCBHR and will bring with them extensive expertise in the field of molecular biology gained in the previous three years in the world leading cytokine lab of Prof. Charles Dinarello.
Professor Han Bucher from University of Zurich visited Monash Newborn and the RCBHR in Sept 08 and gave a series of lectures. Professor Bucher’s research group is one of the leading groups in the use of near infrared spectroscopy to study brain physiology and pathology in babies.
Symposia
First Symposium on functional echocardiography and neonatal hemodynamics organised and hosted by Dr. Arvind Seghal (Monash Newborn) in Oct. 2008: Attended by more than 100 delegates (interstate and international) with invited interstate and international speakers.
New Appointments
Monash Newborn is pleased to welcome Dr Kenneth Tan and Dr David Baldwin to their consultant staff and research team. The focus of Kenneth’s research is on signal processing and development of expert systems that can guide clinical decision-making, while David’s expertise is in the field of respiratory physiology and control of breathing.
Completed projects
- Novel approaches for assessing the development of cardiovascular control after preterm birth. Andrew Ramsden (Monash Newborn), Rosemary Horne, Lisa Walter and Michele Hepponstall (RCBHR). This project has identified that infants with diminished heart rate variability are more likely to develop clinically significant hypotension. With further development this may offer a means by which infants at greatest risk of cardiovascular compromise can be preemptively identified and treated.
- Evaluating neonatal intensive care for extremely low birthweight or very preterm infants born in Victoria in 2005. Elizabeth Carse and Margaret Charlton (Monash Newborn) for the Victorian Infant Collaborative Study Group. This project has compared the outcomes of preterm babies born recently (in the last 2 years) with the outcome of those born over the previous 20 years.
Current projects
- Analysis of chest wall movement as an indicator of lung inflation in high frequency ventilation. Andrew Ramsden and Atul Malhotra (Monash Newborn) and Philip Berger (RCHBR). This poject has developed a technique with which the degree of lung inflation can be determined from analysis of chest wall movement in infants receiving high frequency ventilation. This offers the potential to reduce lung injury during intensive care.
- Analysis of patterns of body and limb movement as an objective measure of brain injury. Andrew Ramsden and Atul Malhotra (Monash Newborn), Robert Griffiths (RCBHR and Howard Florey Institute) and Prof Malcolm Horne (Brain Injury and Repair Group, Howard Florey Institute). This project is designed to explore whether analysis of body movements in conditions such as neonatal abstinence syndrome, birth asphyxia and extreme prematurity may provide early indication of significant brain injury. This project has received grant support of $19,250 from the Fred P Archer Charitable Trust.
- A new acoustic technique to monitor airway patency in infants with apnoea. Andrew Ramsden (Monash Newborn) and Elaine Stockx and Philip Berger (RCBHR). This projt is examining the utility of a novel device (AirwayClear) developed in collaboration between Monash Newborn and the RCBHR in monitoring airway patency in newborn infants. It may offer improved care for infants with apnoea and a variety of upper airway abnormatilies. This project has received grant support of $20,000 from The Equity Trust.
- Novel approaches for assessing the development of cardiovascular control after preterm birth. Andrew Ramsden (Monash Newborn) and Rosemary Horne, Lisa Walter and Michele Hepponstall (RCBHR). This project explored the development of cardiovascular control in the first days after very preterm birth. It demonstrated a strong association between immature and diminished heart rate variability and the development of significant hypotension. With further development this could provide a useful indicator of infants at high risk of cardiovascular compromise.
- Chronic lung disease in the preterm neonate: Investigating the Protein C pathway as potential therapeutic target. Alex Veldman (Monash Newborn) and Philp Berger, Elisabeth Skuza and Elaine Stockx (RCBHR) and Marcel Nold, Claudia Nold and Charles Dinarello (University of Colorado, Denver, USA). This project is investigating the potential of the anti-inflammatory serine protease Protein C in an animal model of neonatal chronic lung disease. Pilot data indicates that this might be the key in developing a treatment for one of the most devastating problems in neonatal medicine with annual treatment costs which are second only to treating asthma and far exceeds the costs for treating cystic fibrosis.
- Chronic lung disease in the preterm neonate: Investigating the cytokine profile of affected infants from birth to term. Alex Veldman (Monash Newborn) and Marcel Nold, Claudia Nold and Charles Dinarello (University of Colorado, Denver, USA). In this project, we apply a new method which allows us to investigate the plasma concentration of 36 different cyotokines in the plasma of preterm neonates by using as little as 2 drops of blood. This data will help us to develop and target new anti-inflammatory proteins at this major problem of surviving preterm neonates.
- MRI/MRS and 2 channel EEG in predicting clinical outcome in infant with hypoxic ischaemic brain injury. Flora Wong and Hazel Aug (Monash Newborn), Stacey Goergen (Department of Radiology), Jeanie Cheong (Royal Women’s Hospital). In this project, we use neurological assessment, bedside EEG monitor, together with early MR brain imaging, to correlate with outcome at two years of age in infants born with perinatal asphyxia and who suffered hypoxic ischaemic brain injury.
- Novel approaches for assessing cerebral circulation and oxygenation in preterm human infants. Flora Wong (Monash Newborn), Adrian Walker (RCBHR), Simon Hew (RCBHR). In this project, we apply near infrared spectroscopy (NIRS) to continuously and non-invasively monitor the brain oxygen level of sick preterm infants undergoing intensive care. We aim at elucidating the changes in brain oxygen levels in the first three days after birth, in relation to fluctuation in blood pressure and use of inotopic medications.
- Developmental changes in cerebral oxygenation after term and preterm birth. Flora Wong (Monash Newborn), Rosemary Horne and Adrian Walker (RCBHR). In this project, we apply NIRS to study the changes in brain oxygenation levels during sleep in the first six months after term corrected age, and compare the difference in babies born term and preterm.
- Signal processing of monitored physiological data in newborn infants receiving intensive care (McMaster University REB registered number 06-195). K Tan (Paediatrics,) A Jeremic (Biomedical Engineering). Physiological variables are routinely monitored in the NICU. Statistical analysis of this data may aid in clinical monitoring (by reducing false alarm rates) and in risk prediction models (length of stay, survival). This project completed recruitment in April 2008. Data analysis in currently ongoing.
- Health in adolescence of survivors of extremely low birth weight or extreme prematurity. Victorian infant collaborative study incl, Elizabeth Carse, Margaret Charlton (Monash Newborn). In this project, we look at physical and mental health of extremely preterm babies in their late teens with the aim of identifying any particular health risks for these teenagers later in adult life.
- Early school-age outcomes after exposure to repeat prenatal corticosteroids: a randomised controlled trial. ACTORDS study group including E Carse, M Charlton (Monash Newborn). In this project we seek to further define later outcomes of a cohort of babies whose mothers were treated with repeat doses of corticosteroids antenatally, and whose two year outcome has been published. (Outcomes at 2 years after repeat doses of antenatal corticosteroids. Crowther et al. N Engl J Med 2007;357:1179-89).
- Is MRI in conjunction with proton MR spectroscopy predictive of clinical outcome in infants with hypoxic ischaemic brain injury. S Goergen (Diagnostic Imaging), E Carse, M Charlton (Monash Newborn). MRI is frequently used in the newborn period to identify brain injury and predict later outcome. This project seeks to assess its precision if two MRI modalities are combined.
- A randomised controlled trial to compare the effect of 80% and 70% incubator humidity on the body temperature of infants born at 28 weeks gestation or less. AM Medhurst, YS Kong (Monash Newborn). In this project, we evaluate the effect of different amounts of humidity in the incubator to provide a surrounding in which the very preterm baby can best maintain its body temperature and fluid balance.
- Evaluation of lateral CXR as a marker of left atria enlargement in infants with patent ductus arteriosus. A. Seghal (Monash Newborn), Gillian Whitele (Dept. Radiology) and Sarah Hope (MonashHeart). The sensitivity of frontal CXR to diagnose cardiomegaly (enlargement of the heart) is about 40%. We believe this is so because the heart enlarges initially not sideways (picked up by frontal CXR) but backwards (left atria enlargement), which would be better picked by a lateral CXR. This would be correlated with chamber size on echocardiography.
- Effect of indomethacin on cardiovascular hemodynamics in preterm infants. A. Seghal, A. Ramsden (Monash Newborn). Indomethacin is used commonly for medical closure of a patent ductus arteriosus (PDA) in preterm babies. There is limited animal and human data on effects of indomethacin on cardiac performance and virtually no data on its effects on Coronary circulation.
Publications, awards, funding and postgraduate students summary
Journal articles 20
Conference presentations 22
Awards and prizes 3
Postgraduate research students 2
Funding:
- Fred P Archer Charitable Trust
- Griffin Global Pty Ltd
- Marian & E.H. Flack Trust
- NHMRC
- Pulmosonix Pty Ltd
- The Equity Trust
- Windermere Foundation Grant
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