Centre of Research Excellence in Newborn Medicine
Problems around birth are common and can have long-term implications, including into adulthood. Our goal is to improve health outcomes for all newborn babies and their families by determining factors that enhance their health and assessing the benefits and consequences of new treatments for mothers and babies. The Centre for Research Excellence in Newborn Medicine is a world leading team dedicated to training the next generation of health professionals in the care of newborn babies, in Australia and the rest of the world.
- Our overall aim is to improve health outcomes of all newborn infants and their families.
- Our research objective is to improve the physical, cognitive, behavioural, psychological and other health outcomes for newborn infants and their families.
- Our translation objective is the early identification of high-risk infants and families, and to ensure effective treatments are introduced efficiently into clinical practice, and ineffective or harmful treatments are abandoned.
- Our training objective is to broaden the research skills of health professionals who care for newborn infants. We aim to be the leading centre internationally for clinical research training in newborn medicine.
- Our collaborative objective is to increase our national and international collaborations to tap the skills of world experts to address a broader range of important research questions in newborn medicine.
Professor Lex Doyle is a Neonatal Paediatrician at The Royal Women’s Hospital with a particular interest in improving long-term outcomes for high-risk babies. Professor Doyle has major research interests in evaluating neonatal intensive care, including how to improve on care, and its economic consequences. He has been a Chief Investigator on numerous randomised controlled trials of interventions before and after birth designed to improve the outcome for the highest-risk babies, including the tiniest and most immature babies. Professor Doyle also leads or has led several research groups interested in the outcome for tiny babies well beyond the nursery and into adulthood; these are the Premature Infant Follow-up Programme at the Royal Women's Hospital, and the Victorian Infant Collaborative Study (VICS) Group (Convenor from 1991 until 2014). He is also a senior member of the Victoria Infant Brain Studies (VIBeS) Group. As a consequence of his research activities he has over 400 original scientific publications, over 70 review articles or editorials, 1 book, and two completed theses (MSc [McMaster 1982]; MD [Melbourne 1989]) to date.
Professor Peter Davis
Professor Peter Davis has been a consultant neonatologist at The Royal Women’s Hospital, Melbourne since 1993. He trained in Brisbane, Australia and McMaster University, Canada where he developed an interest in Clinical Epidemiology and Evidence Based Medicine. He is currently the Professor/Director of Neonatal Medicine and leads a young team of enthusiastic clinical researchers interested in improving the care of babies in the delivery room and in the intensive care unit. Professor Davis is a substantial contributor to the Cochrane Collaboration and a member of the neonatal subcommittee of the International Liaison Committee on Resuscitation (ILCOR). His research interests include non-invasive ventilation and newborn resuscitation.
A/Professor Peter Anderson
Associate Professor Peter Anderson is a psychologist and Principal Research Fellow at the Murdoch Childrens Research Institute and The University of Melbourne. He is Director of the Victorian Infant Brain Studies (VIBeS) team and co-director of the Australian Centre for Child Neuropsychological Studies (AC-CNS), the leading centre for paediatric neuropsychological research in Australia. Associate Professor Anderson’s research is focussed on understanding the mechanisms underlying neurodevelopmental problems in children born preterm. He is involved in observational and neuroimaging studies, and randomised controlled trials assessing the effects of obstetric, neonatal, and developmental interventions.
Cochrane Collaboration regional coordinator for Australasia: 2000 –present; Member of Editorial Panel, Journal of Paediatrics and Child Health, 2004 – present; Editorial panel of Seminars in Fetal and Neonatal Medicine 2013 – present; Editorial panel of Maternal Health, Neonatology and Perinatology 2013-present; Membership of the ILCOR since 2009.
Health ambassador, Life’s Little Treasures Foundation.
- The University of Melbourne
- Royal Children’s Hospital
- The Royal Women’s Hospital
- Monash University
- Monash Children’s Hospital
- Mercy Hospital for Women
- UK – University College, London
- Netherlands – Utrecht
- USA – Boston, Philadelphia
- Canada – McMaster University
- Finland - Helsinki
- APIC (Adults born Preterm International Collaboration)
- Adelaide University (Makrides, Gibson)
- Life’s Little Treasures Foundation
New treatments for resuscitation and ongoing respiratory support of newborn infants
Neonatal resuscitation is one of the most commonly performed medical interventions. A large number of physiological changes occur in the cardiorespiratory system in the first minutes after birth. Small, sick and preterm infants may require assistance to breath. In Australia in 2011, 24% (n=55,233) of all newly born infants received some form of assistance at birth with 7.3 % receiving breathing support via a face mask or an endotracheal tube. Our group undertakes clinical trials to develop and test new strategies to improve neonatal resuscitation in the delivery room (DR) in order to reduce mortality and morbidity. Our studies include measuring exposure to oxygen in the DR, identifying biomarkers that could predict infants most at risk for development of chronic lung disease and a randomised trial to determine the effect of timing of clamping and cutting the umbilical cord after birth on heart rate in newly born infants. We will also test the effect of a sustained inflation on the transition to ex utero life in very preterm infants. The results from our studies will be directly translatable to clinical practice.
Improving child neurodevelopment in preterm children born <34 weeks' gestational age and their family’s mental health and functioning through a clinician supported web-based intervention
Survival rates for the most immature infants have risen dramatically, however rates of major adverse neurodevelopmental outcomes in these tiny survivors are higher than in term born infants. Parents of preterm children have an increased risk for mental health difficulties compared with parents of children born at term, and these difficulties have been associated with worse developmental outcomes for preterm children. We know that developmental interventions for preterm infants after discharge improve early childhood development. To improve availability of a successful developmental care home-visiting program developed by our group, as well as to provide intervention earlier and reduce the unit cost of treatment, we have adapted the program to a clinician supported web-based program. Aims: to determine if a web-based developmental program improves the neurodevelopment of infants born <34 weeks and their families’ mental health and functioning at 2 years (corrected) age. Study Design: 103 infants born <34 weeks and their families were recruited into an RCT where families were randomly-allocated to receive the web-based program or usual care. We are currently delivering the intervention to families, and inviting families to participate in 1 and 2 years' corrected age follow up assessments. Significance: If we can prove that this web-based program improves outcomes in a high-risk population, it can be tested in other groups, easily translated into clinical practice, able to reach large numbers of families, and should have a very favourable cost-effectiveness ratio.
Understanding brain development – novel magnetic resonance imaging markers for early prediction of adverse neurodevelopmental outcomes in paediatric populations
Magnetic resonance imaging (MRI) is a powerful non-invasive method for providing insight into brain development and can be used to predict adverse neurodevelopmental outcomes. Multimodal imaging including structural, diffusion, functional, and spectroscopy are able to provide complementary information on brain macrostructure, microstructure, function, connectivity and metabolism. We aim to develop MRI biomarkers for early prediction of later neurodevelopmental outcomes, and to evaluate the effectiveness of interventions designed to improve those outcomes. We have one of the largest libraries of around 2000 scans on preterm and control subjects ranging from term-equivalent (40 weeks) to 18 years of age, including rare longitudinal MRI data of infants scanned at term-equivalent, seven years and 13 years of age. We are developing cutting edge paediatric MRI tools and using existing advanced MRI techniques to help us understand brain development, the progression of early brain injury and the relationships between early brain abnormalities and neurodevelopmental outcomes.
Understanding the school-age outcomes of “late” preterm infants
Late preterm infants, those born between 34 and 37 weeks’ gestation, are of great public health importance. They represent the greatest proportion of all babies born early, and make up about 6% of the general population. Most research has focussed on the very tiny and most immature babies, although we now understand that late preterm children are also at risk of poor long-term health and developmental outcomes. We aim to follow-up a large cohort of late preterm children and matched term controls, find out more about their health and development as they start school, and set the scene for a more detailed assessment during primary school, to better understand their strengths and vulnerabilities.
Adult outcomes of very preterm birth – a synthesis of worldwide data
From small studies reporting the outcomes of young adults born very preterm in the late 1970s and early 1980s, we know that poorer educational achievement and higher rates of depression, anxiety and poorer social functioning occur in preterm survivors than in term controls. Preterm adults are also at increased risk of a variety of medical conditions, such as hypertension, impaired insulin sensitivity and glucose tolerance, and impaired renal and respiratory function compared with term controls. Although the majority of preterm subjects rate their health-related quality of life similarly to that of controls, fewer marry and have children. However, adult outcomes have been assessed on relatively small numbers of subjects within individual studies, resulting in wide variation and uncertainty in the reported rates of outcomes, limiting the generalisability and reliability of the data obtained. We aim to collaborate with colleagues internationally to compare adult outcomes between very preterm and term subjects and to identify earlier predictors of adverse outcomes. Individual patient data will be pooled across international studies, which will improve generalisability, assist with adjustment for confounding variables, and increase statistical power to find differences between groups and to assess predictors of outcome.
Research Update: Magnesium sulphate study
Magnesium sulphate given to women who are likely to deliver their baby too early (<30 weeks) to protect their unborn baby’s brain have no obvious long-term harms or benefits on children so treated at school-age. This is the main message of a large collaborative study completed in Australia and New Zealand by the Australasian Collaborative Trial of Antenatal Magnesium Sulphate (ACTOMgSO4) Study Group, as reported in the Journal of the American Medical Association ( JAMA 2014; 312:1105-1113). Of 867 survivors available for follow-up, outcomes at school age (corrected age 6-11 years) were determined for 669 (77%). Children were thoroughly evaluated for problems with brain functioning, including thinking ability, movement skills, memory and attention, as well as with general health and well being; no problems were identified that were related to treatment with magnesium sulphate before birth.
Research Update: Postnatal corticosteroids study
Postnatal corticosteroids given to prevent or treat lung injury in the newborn period can have harmful long-term effects. However, if used in infants at highest risk of lung injury, the benefits of treatment seem to outweigh the risks. This is the conclusion of a study re-examining the balance of risks and benefits from reports of all randomised trials of corticosteroids, to be reported in the Journal of Pediatrics.