Improving Breathing Support For Newborn Infants In Non-Tertiary Centres: The HUNTER Trial
Funder
National Health and Medical Research Council
Funding Amount
$1,203,844.00
Summary
Every year in Australia, thousands of newborn babies have breathing difficulties. Our trial will study a new, simple method of providing breathing support to newborn babies in special care nurseries, called high-flow (HF). HF is cheaper, easier to use, and more comfortable for babies than the current standard treatment, called CPAP. If HF is as good as CPAP at supporting babies' breathing, it will change practice in Australia and around the world.
Human Amnion Cells As A Therapy For Preterm Lung Disease
Funder
National Health and Medical Research Council
Funding Amount
$104,664.00
Summary
Premature babies often have serious breathing difficulties due to immature lungs, and these can remain life long. Amnion cells, which are from the membrane that surrounds the baby and placenta in the womb, behave like stem cells and can develop into lung cells. Using an animal model, we will give these cells to damaged premature lungs, and see if they can repair the lung tissue. We are hopeful this will improve the survival of premature babies and help prevent long term lung disease.
The survival of a baby at birth is crtically dependent upon the ability of the lungs to successfully take over the role of exchanging oxygen and carbon dioxide between the air and blood. To perform this task, during fetal life the lung must have grown properly and near the end of gestation it must mature both structurally and biochemically. Thus, babies that are born early, before the expected time of birth, are born before the lungs have had the opportunity to mature. It is not surprising, ther ....The survival of a baby at birth is crtically dependent upon the ability of the lungs to successfully take over the role of exchanging oxygen and carbon dioxide between the air and blood. To perform this task, during fetal life the lung must have grown properly and near the end of gestation it must mature both structurally and biochemically. Thus, babies that are born early, before the expected time of birth, are born before the lungs have had the opportunity to mature. It is not surprising, therefore, that an inability to breathe is one of the primary problems faced by a prematurely born infant. During late gestation the lung changes dramatically in order to increase its ability to exchange gases. There is an increase in surface area and a reduction in the barrier thickness between the airspace and the blood stream. The molecular mechanisms involved in this remodelling are unknown, but it is known that the administration of corticosteroids to women at risk of preterm labour causes a large decrease in this barrier thickness and increases the distensibility of the lung. This project seeks to understand how the structure of the lung matures in late gestation and to determine whether corticosteroids regulate these changes by altering the structure of a specialised molecule, called versican. Versican resides in the tissue space outside of cells and has special properties that allow it to retain water and help organise the surrounding matrix. We propose that alterations in the structure of versican will reduce its ability to retain water, thereby reducing the tissue volume and contributing to a reduction in the air-blood tissue barrier within the lung.Read moreRead less
Improving Lung Protective Mechanical Ventilation In The Newborn Using Regional Lung Mechanics
Funder
National Health and Medical Research Council
Funding Amount
$249,130.00
Summary
Premature babies are at risk of severe, and potentially long-term, lung damage. These complications can be minimised if babies lungs are optimally supported from birth. Dr Tingay will examine the influence of different strategies for using mechanical ventilators to help inflate the lung at birth, and their interactions with other therapies used to enhance lung maturity, using exciting new imaging technologies. It will provide new insights into helping vulnerable preterm babies.
Lung Injury Following Resuscitation In Immature Lambs
Funder
National Health and Medical Research Council
Funding Amount
$227,036.00
Summary
The primary aim of this project is to identify techniques for resuscitating premature babies that cause little or no damage to their lungs. We also want to identify factors that enhance the clearance of liquid from the lungs so air can easily enter to deliver oxygen and remove carbon dioxide at birth. About 1% of babies are born very prematurely and many develop respiratory distress syndrome (RDS). This is the major cause of illness and death in infants born at less than 32 weeks' gestation. Mos ....The primary aim of this project is to identify techniques for resuscitating premature babies that cause little or no damage to their lungs. We also want to identify factors that enhance the clearance of liquid from the lungs so air can easily enter to deliver oxygen and remove carbon dioxide at birth. About 1% of babies are born very prematurely and many develop respiratory distress syndrome (RDS). This is the major cause of illness and death in infants born at less than 32 weeks' gestation. Most of the survivors required assisted ventilation during their first weeks of life. In 1995, 2381 premature infants were ventilated in Australia and New Zealand, requiring 36,407 days of ventilator care. Thus, this is a serious condition with a high financial and social cost. It is known that RDS is caused by damage to the very immature lung which starts an inflammatory reaction. We don't know what triggers the damage and inflammation but believe that the way babies are resuscitated may damage the lungs. Currently, babies are resuscitated with a resuscitation bag squeezed by hand, with 100% oxygen. There is no pressure to stop the lungs collapsing during expiration. As the volume of gas delivered with each breath is not measured, it is possible that the volumes are too large and damage the lungs. This project will investigate whether less damage occurs to the lungs of preterm lambs when resuscitation uses a modern neonatal ventilator where each inflation is limited to a known volume. A small distending pressure will be used to stop the lungs collapsing during expiration. We will also investigate factors that enhance the clearance of liquid from the lungs after the initiation of breathing. The failure to clear lung liquid greatly limits the ability of babies to breathe and exposes those parts of the lung that are cleared to a much greater risk of injury. The results of this study will be directly applicable to the treatment and care of prematurely born babies.Read moreRead less
RCT Of Headbox Oxygen Vs CPAP For Neonatal Respiratory Distress In Non-tertiary Hospitals
Funder
National Health and Medical Research Council
Funding Amount
$225,500.00
Summary
Each year in NSW hundreds of babies are transferred from local general hospital nurseries to a hospital with Neonatal Intensive Care Unit (NICU) because of breathing difficulties. Frequently, mothers are unable to accompany their babies at the time of transfer, leading to stress. When a mother is eventually transferred she is often separated from her partner and local supports causing further anxiety. In addition, if a baby has to be transferred, invasive procedures may be needed to ensure safet ....Each year in NSW hundreds of babies are transferred from local general hospital nurseries to a hospital with Neonatal Intensive Care Unit (NICU) because of breathing difficulties. Frequently, mothers are unable to accompany their babies at the time of transfer, leading to stress. When a mother is eventually transferred she is often separated from her partner and local supports causing further anxiety. In addition, if a baby has to be transferred, invasive procedures may be needed to ensure safety. Currently, babies who need oxygen in a local hospital are placed in a crib with a clear plastic box around their head and oxygen is run into the box (headbox oxygen). There is an alternative method of providing oxygen called CPAP (Continuous Positive Airway Pressure). This involves giving the oxygen directly into the baby's nose via soft rubber prongs. CPAP has been used since the 1970's. It is the main form of respiratory support for infants in many NICUs in Australia and the world. There is some evidence that death and lung disease may be reduced. However, the babies in these studies are sicker and smaller than babies in local hospital nurseries. CPAP is used in some local nurseries in New Zealand, however no studies have been done to see if CPAP reduces the need for inter-hospital transfer. The study will involve hospitals that have been selected because of their level of on site medical and nursing staff. These hospitals will have support and advice from two NICUs that use CPAP as their main form of respiratory support. Babies who need oxygen will be randomly allocated to either have headbox oxygen or CPAP. If the baby becomes so unwell such that certain preset criteria are met, the baby will be transferred to a NICU in the usual way. If CPAP safely reduces the need for inter-hospital transfer, many parents will be saved the anxiety associated with transfer, and the separation it often causes.Read moreRead less
Optimising Respiratory Care Of The Preterm Infant Using Regional Volumetric Strategies
Funder
National Health and Medical Research Council
Funding Amount
$282,086.00
Summary
Preterm birth is defined by the fragile under-developed lung needing to engage in air-breathing. Most preterm babies need respiratory support, but used inappropriately these life-saving therapies can increase the risk of long-term lung injury. This Fellowship will support a program designed to generate clinically meaningful outcomes through molecular, translational and clinical studies founded on strong physiological and biological principles and innovative research techniques.
Hyperpolarized Helium MRI To Quantify Regional Lung Damage And Ventilation For Improvement Of Recruitment Strategy.
Funder
National Health and Medical Research Council
Funding Amount
$455,160.00
Summary
Many lung injuries need mechanical ventilation to reopen collapsed lung airspaces and supply oxygen to the patient. This study uses two methods to monitor the lungs during ventilation: Hyperpolarised helium MRI to image the airspace, and electrical impedance tomography to measure lung volume. This information will allow adjustment of ventilator pressure to maximize oxygen transfer without increasing lung damage. Quicker repair of lung damage and patient recovery are the benefits of this study.
Centre For Research Excellence In Advanced Cardio-respiratory Therapies Improving OrgaN Support (ACTIONS)
Funder
National Health and Medical Research Council
Funding Amount
$2,593,631.00
Summary
Artificial hearts and lungs are increasingly used to support our most critically ill patients. A greater understanding of patient-machine interaction is needed to maximise their life-preserving potential. ACTIONS CRE will research device-related complications, improve device components, develop clinical practice guidelines, train clinical and engineering researchers and explore the cost benefits of this technology ensuring all Australians can access state-of-the-art mechanical life support.
Optimising Lung Surfactant Protein Production In The IUGR Fetus At Risk Of Preterm Delivery
Funder
National Health and Medical Research Council
Funding Amount
$463,853.00
Summary
Pregnant women at risk of preterm labour after 24 weeks gestation are increasingly administered glucocorticoids in Australian hospitals in order to promote fetal lung maturation and a successful transition to extrauterine life. Antenatal glucocorticoid treatment reduces overall neonatal mortality, the risk of respiratory distress syndrome and the need for respiratory support. Babies that are born small may not benefit from this treatment in the same way that average size babies benefit.