Paediatric Intensive Care Research

The Paediatric Intensive Care Research group at Murdoch Children’s Research Institute (MCRI) is dedicated to improving outcomes for critically ill children.

We work across a broad range of diseases and conditions affecting critically ill children, with impact at local, national, and international levels.

Our research focus

Our research focuses on both short and long-term recovery for children admitted to intensive care, aiming to:

• enhance survival rate
• reduce complications
• support better quality of life after discharge

We lead and collaborate on clinical research that addresses the most pressing challenges in paediatric intensive care. Our key areas of investigation include:

• Cardiac conditions: Improving care for children with congenital and acquired heart disease.
• Aquired brain injury: Understanding and minimising the impact of acquired brain injuries.
• Lung disease: Advancing treatments for respiratory failure and severe lung conditions.
• Sepsis: Identifying better ways to diagnose and treat life-threatening infections.
• Renal replacement therapy: Optimising kidney support for critically ill children.
• Extracorporeal membrane oxygenation (ECMO): Evaluating the use and outcomes of ECMO in paediatric care.
• Long-term outcomes: Tracking recovery and quality of life after intensive care

Our research team

The Paediatric Intensive Care Research group is led by Professor Warwick Butt and Associate Professor Tom Rozen, Director of PICU. Our team includes experienced consultants who are actively involved in research alongside their clinical roles, as well as a dedicated group of research nurses, many of whom hold postgraduate qualifications.

We are supported by a multidisciplinary team (MDT) that includes experts in clinical technology, pharmacy, and other allied health areas. Many of our clinical staff are also engaged in research and quality improvement projects as part of their everyday roles in the PICU.

We support international visiting researchers and students, and have previously supported projects as part of Master of Science, Biomedical Science, PhD programs, and clinical electives. Staff from all departments within the ICU — medical, nursing, and technology — are encouraged to participate in research activities.

Our team is currently involved in a wide range of studies at the local, national, and international levels, all aimed at improving outcomes for children with life-threatening illnesses.

The PICU at the Royal Children’s Hospital is also a proud member of the Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG).

More information

Paediatric Emergency Medicine Centre of Research Excellence 

Our projects

Early prophylactic peritoneal dialysis in infants postcardiac surgery (EPICS)

This randomised, open-label two group trial investigates whether early peritoneal dialysis (PD), started soon after cardiac surgery, can reduce major adverse events in infants, such as:

• cardiac arrest, emergency chest reopening, the need for extracorporeal membrane oxygenation (ECMO), and death.
• early PD shortens the duration of mechanical ventilation and intensive care stays.

Study participants will also have long-term follow-up and we also plan to estimate health care costs.

Oedema study

Fluid accumulation and oedema are common challenges in managing critically ill children. It can cause a significant impact on patient outcomes such as length of mechanical ventilation and intensive care stay.

This study uses innovative techniques and assessments, including 3D photography, to measure oedema in ways not previously done in paediatric intensive care.

The study aim to improve clinical understanding and management of these commonly encountered problems in critically ill children.

Nitric oxide during cardiopulmonary bypass (NITRIC trial)

This blinded, randomised controlled trial involves 1,320 infants under two years of age undergoing cardiac surgery with cardiopulmonary bypass (CPB). This will be conducted in six paediatric cardiac surgical centres.

Participants will be randomised into one of two treatment types:

• Intervention type will receive nitric oxide 20 ppm into the Cardio-Pulmonary Bypass (CPB) circuit.
• The control type will not receive nitric oxide.

The primary outcome will be how long the patients are ventilated in the first 28 days. Secondary outcomes include the length of stay in intensive care and in hospital and healthcare costs.

NASO trial

A randomised controlled trial of nitric oxide administration during cardiopulmonary bypass in infants undergoing Arterial Switch Operation for repair of transposition of the great arteries.

This study aims to explore the impact of exposure to nitric oxide on bypass in infants who are undergoing an arterial switch (ASO) for correction of Transposition of the Great Arteries (TGA).  This is a multi-centre randomised controlled trial. Participants will be randomised (into one of two treatment arms:

• The intervention arm will receive nitric oxide 20 ppm into the Cardio-Pulmonary Bypass (CPB) circuit.
• The control arm will not receive nitric oxide.

At the end of the surgery, the patient will return to the Intensive Care Unit where normal care will continue. Approximately 20-30 centres across four continents are expected to participate.

Gene expression to predict outcomes after infant heart surgery – NITRIC follow-up study

This multicentre study builds on an NHMRC-funded trial of 1,320 infants with congenital heart disease (CHD) undergoing cardiopulmonary bypass (CPB) surgery.

Using biobank samples, this worldwide, unique study aims to develop novel diagnostic approaches to identify early children at high risk of poor short- and long-term outcomes after CPB.

The project outcomes will improve our understanding of the molecular mechanisms underlying the deleterious response to CPB.

Intensive care point prevalence studies looking at PICU practice

This joint initiative by the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) and the George Institute for International Health provides a systematic snapshot of ICU practices. It includes adult, paediatric, and mixed ICUs across Australia and New Zealand, helping to benchmark and improve clinical care.

Life after Paediatric Critical Illness (LPCI)

An integrated multi-stage evaluation of functional outcome, quality of life trajectories & their determinants in children

While survival rates in PICU have improved, more children are living with moderate to severe disabilities. This study tracks quality of life, hospitalisation data, and long-term outcomes to better understand how critical illness affects children after PICU. 

Gaining a clear understanding of these factors in children recovering from critical illness in Victoria will help identify how disease and treatment influence long-term outcomes. The findings will guide improvements in care and recovery support.

Other studies

Chronic PICU patients: profile, burden, and outcomes

This series of studies explores the changing profile of children requiring prolonged intensive care. It examines the burden on healthcare providers, long-term outcomes for patients, and identifies key challenges. The goal is to develop recommendations to improve care quality both in the PICU and after discharge.

Improving outcomes for neonates undergoing heart surgery for congenital heart disease

We are conducting multiple studies focused on neonates undergoing surgery for congenital heart disease. These studies investigate how developmental stage, organ system maturity, and intensive care practices influence both short- and long-term outcomes in this high-risk group.

International collaborations

Our team contributes to several global research initiatives aimed at improving paediatric intensive care. These include studies such as ASCEND, PROSPECT, ADAPT, THRIVE, and RESPOND, which explore clinical care practices and outcomes across diverse settings.

Quality assurance projects

We are actively involved in quality improvement initiatives, including the investigation of adverse events in PICU. These projects aim to enhance patient safety and care standards through continuous monitoring and evaluation.

Funding

Thank you to our supporters.

• ANZICS Foundation
• National Heart Foundation of Australia
• Medical Research Future Fund (MRFF)
• Royal Children's Hospital Foundation

Collaborations

We partner with leading institutions worldwide, including:

• Australian & New Zealand Intensive Care Society (ANZICS)
• ANZICS Paediatric Study Group (PSG)
• ANZICS Clinical Trials Group (CTG)
• Australian & New Zealand Paediatric Intensive Care Registry
• ANZICS CORE
• Queensland Children's Hospital
• Gold Coast University Hospital:
• Monash Children’s Hospital Melbourne:
• Perth Children's Hospital, Perth:
• Women's and Children's Hospital, Adelaide
• Sydney Children's Hospital, Sydney:
• The Children’s Hospital at Westmead, Sydney
• Starship Children's Hospital, Auckland, NZ
• University Children's Hospital Zurich, Zurich, Switzerland.
• Texas Children's Hospital
• Boston Children’s Hospital
• The University of Melbourne
• University of Queensland

Featured publications

Goldfeld S, Paton K, Lei S, Perera P, Hiscock H. Trends in rates and inequalities in paediatric admissions for Ambulatory Care Sensitive Conditions in Victoria, Australia (2003 to 2013). J Paediatr Child Health. 2021 Jun;57(6):860-866. doi: 10.1111/jpc.15338. Epub 2021 Jan 11. PMID: 33432713.

Stukas S, Higgins V, Frndova H, Gill J, Hubara E, Guerguerian AM, Boutis K, Beauchamp M, Farrell C, Babl FE, Delzoppo C, Greenham M, Wilkinson AA, Crichton A, Anderson V, Adeli K, Hutchison J, Wellington C; Serum Biomarkers and Quality of Life in Children with Traumatic Brain Injury investigators; National Biobank and Database for Patients with Traumatic Brain Injury investigators; Canadian Critical Care Translation Biology Group, and the Canadian Traumatic Brain Injury Research Consortium. Characterisation of serum total tau following paediatric traumatic brain injury: a case-control study. Lancet Child Adolesc Health. 2019 Aug;3(8):558-567. doi: 10.1016/S2352-4642(19)30194-4. Epub 2019 Jun 21. PMID: 31231066.

Finch-Edmondson M, Morgan C, Hunt RW, Novak I. Emergent Prophylactic, Reparative and Restorative Brain Interventions for Infants Born Preterm With Cerebral Palsy. Front Physiol. 2019 Jan 28;10:15. doi: 10.3389/fphys.2019.00015. PMID: 30745876; PMCID: PMC6360173.

Weiss MJ, Pérez Blanco A, Gelbart B. Special issues in pediatric deceased organ donation. Intensive Care Med. 2019 Mar;45(3):361-363. doi: 10.1007/s00134-019-05523-2. Epub 2019 Feb 6. PMID: 30725135.

George S, Humphreys S, Williams T, Gelbart B, Chavan A, Rasmussen K, Ganeshalingham A, Erickson S, Ganu SS, Singhal N, Foster K, Gannon B, Gibbons K, Schlapbach LJ, Festa M, Dalziel S, Schibler A; Paediatric Critical Care Research Group (PCCRG), Paediatric Research in Emergency Departments International Collaborative (PREDICT) and the Australia and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG). Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids THRIVE): a protocol for a randomised controlled trial. BMJ Open. 2019 Feb 20;9(2):e025997. doi: 10.1136/bmjopen-2018-025997. PMID: 30787094; PMCID: PMC6398737.

Ferrazzano PA, Rosario BL, Wisniewski SR, Shafi NI, Siefkes HM, Miles DK, Alexander AL, Bell MJ. Use of magnetic resonance imaging in severe pediatric traumatic brain injury: assessment of current practice. J Neurosurg Pediatr. 2019 Apr 1;23(4):471-479. doi: 10.3171/2018.10.PEDS18374. Epub 2019 Feb 8. PMID: 30738383; PMCID: PMC6687576.