Respiratory failure at birth is a major cause of death and disease in newborn infants. At birth the airways must be cleared of liquid to allow the inhalation of air, but, little is known about the process of lung aeration, because it has not been possible to observe or measure it. We have developed imaging and analytical techniques to observed and measure lung aeration. We will determine ventilation procedures that promote uniform lung aeration and minimise lung injury in ventilated infants.
Defining Regional Lung Mechanics To Improve Lung Protective Ventilation Strategies In Newborn Infants
Funder
National Health and Medical Research Council
Funding Amount
$287,321.00
Summary
Over 3000 newly born infants require mechanical ventilation in Australia every year. The majority are very premature infants. About 30% of ventilated infants develop serious ventilator induced lung injury. Minimising such lung injury with improved techniques of ventilation which can protect the lung from injury will reduce the considerable short and long term health burden of this population.
Randomised Controlled Trial Of Therapeutic Pulmonary Lavage In Meconium Aspiration Syndrome
Funder
National Health and Medical Research Council
Funding Amount
$182,550.00
Summary
Meconium aspiration syndrome (MAS) is a serious respiratory disease of full term infants, which can lead to very severe respiratory failure. It is caused by the inhalation of meconium, the secretion of the fetal intestine, into the lung at or prior to delivery. As a result, the airways and air sacs within the lung are damaged, leading to difficulty with breathing and poor oxygen levels. About one-third of all infants with MAS require mechanical ventilation in the first days of life, and are ofte ....Meconium aspiration syndrome (MAS) is a serious respiratory disease of full term infants, which can lead to very severe respiratory failure. It is caused by the inhalation of meconium, the secretion of the fetal intestine, into the lung at or prior to delivery. As a result, the airways and air sacs within the lung are damaged, leading to difficulty with breathing and poor oxygen levels. About one-third of all infants with MAS require mechanical ventilation in the first days of life, and are often extremely difficult to manage. At present, the main treatments given to a ventilated infant with severe MAS are supportive, rather than curative. Lung cleansing procedures are not part of routine care in this condition, even though removal of meconium from the lung may reduce the amount of damage that occurs. This project is a randomised controlled trial of a lung cleansing procedure called lung lavage in ventilated infants with severe MAS. During the lung lavage, a quantity of cleansing fluid containing a natural substance called surfactant is introduced into the lung, and then removed by suctioning. This procedure cleanses the lung of some of the meconium, and in preliminary testing, appears to be safe and well-tolerated even in the sickest infants. In the proposed trial, we will randomly allocate ventilated infants with severe MAS to receive either a lung lavage procedure, or routine care. This will take place within 24 hours of birth. We are looking to see whether the lavage procedure shortens the duration of ventilation, oxygen therapy or hospitalisation. Because there are only a small number of ventilated infants with MAS at any one centre per year, we will involve as many Australian neonatal intensive care units as we can in the study. We aim to enrol 66 infants in the trial, of whom half will receive lavage therapy.Read moreRead less
Imaging Lung Aeration And Lung Motion Following Very Premature Birth
Funder
National Health and Medical Research Council
Funding Amount
$517,631.00
Summary
Using a synchrotron as an X-ray source, we will image the lungs as they aerate at birth and optimise ventilation strategies that improve lung aeration while minimising the risk of ventilation-induced lung injury.
I am a neonatologist interested in improving the outcomes of graduates of neonatal intensive care units. Currently the focus of my research is stabilisation immediately following birth and my research portfolio ranges from bench-top and animal studies thr
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
Does Variable Ventilation Offer Physiological And Biological Benefits For The Preterm Lung?
Funder
National Health and Medical Research Council
Funding Amount
$320,278.00
Summary
Lung disease is a significant cause of illness at birth, subsequent breathing problems and death in very premature babies. We know that chronic preterm lung disease results in part from the immature state of the lung at birth, but it appears that inflammation of the lung also plays an important role. We, and others, have shown that this lung inflammation can be a response to injury from mechanical ventilation after birth. In the past, we have sought to strictly control the way that babies are ve ....Lung disease is a significant cause of illness at birth, subsequent breathing problems and death in very premature babies. We know that chronic preterm lung disease results in part from the immature state of the lung at birth, but it appears that inflammation of the lung also plays an important role. We, and others, have shown that this lung inflammation can be a response to injury from mechanical ventilation after birth. In the past, we have sought to strictly control the way that babies are ventilated. We have regulated the pressures used to inflate their lungs, the amount of volume delivered to the lung, the amount of time that the baby has to take a breath. This is a marked contrast to breathing patterns in healthy infants and adults, in which each of these things vary considerably from breath to breath. Recent studies have shown that the presence of variability in breathing patterns is actual essential to the process of staying healthy and maintaining resting lung volume above a critical lower limit. This study will provide unique insights into a new and potentially highly beneficial approaches to ventilation for preterm infants. We will determine if there is a significant clinical benefit of incorporating variability into the ventilatory waveform used to treat newborn babies with lung disease. has the potential to cause a paradigm shift in current concepts of preterm infant ventilatory strategies. Potential long term outcomes include significantly reducing illness and death associated with preterm birth, and promoting a healthier start to life for the over 6000 infants who require ventilatory assistance each year within the Australian and New Zealand neonatal network.Read moreRead less
Necrotising enterocolitis (NEC) is a devastating bowel condition afflicting almost 1 in 10 of very preterm babies. About a third of babies with NEC do not survive. Currently, there is no cure. We propose the use of stem-like cells from the human placenta as a targeted therapy for NEC, working by minimising gut damage and accelerating gut repair.
Nasal CPAP For Very Preterm Infants At Birth: Does It Improve Outcome? A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$460,604.00
Summary
Neonatal respiratory distress syndrome (RDS) is the major cause of morbidity and mortality in preterm infants. Many of these infants need ventilatory support to keep them alive. In 1996 and 1997, 10,471 infants in Australia and New Zealand needed ventilatory support for a total of 72,544 days. This treatment is a great physical burden for the infants and an enormous emotional stress for their parents. Each day of treatment costs about A$2000 so their hospital treatment costs about $72 million a ....Neonatal respiratory distress syndrome (RDS) is the major cause of morbidity and mortality in preterm infants. Many of these infants need ventilatory support to keep them alive. In 1996 and 1997, 10,471 infants in Australia and New Zealand needed ventilatory support for a total of 72,544 days. This treatment is a great physical burden for the infants and an enormous emotional stress for their parents. Each day of treatment costs about A$2000 so their hospital treatment costs about $72 million a year. Of infants born less than 29 weeks' gestational age, about 40% of the survivors subsequently developed chronic lung disease (CLD). This condition is defined as prolonged dependence on supplementary oxygen therapy. CLD is associated with further costs and increased lung problems and readmissions to hospital in the first year of life. Thus, CLD is an expensive and time-consuming condition that has a high social cost. This project will determine whether treating these very premature babies from birth simply by applying oxygen under a low continuous positive pressure (CPAP) into their nose rather than the present treatment of placing a tube in the windpipe (known as intubation) and ventilation will reduce the incidence and severity of neonatal respiratory distress syndrome and subsequent chronic lung disease. The project will involve 600 babies from different, high quality neonatal intensive care units. Babies who are born at less than 29 weeks' gestation and who show signs of breathing at birth will be randomly allocated to be treated with either nasal CPAP or intubation and ventilation. This project will determine whether CPAP treatment at birth improves survival and reduces the severity of the RDS and subsequent CLD, or has no long term beneficial effect. If the trial is successful, this will be one of the most useful new treatments in neonatal medicine because it is simple to use, easier for the babies, and cheaper than ventilation.Read moreRead less
Generating And Applying Clinical Research To Improve The Outcomes Of Neonatal Intensive Care
Funder
National Health and Medical Research Council
Funding Amount
$568,892.00
Summary
Birth is a complex process and sometimes babies require help to make the transition to independent life. Professor Peter Davis is conducting research into how best to support this transition. This involves helping the lungs to work efficiently and supporting the changes in circulation of the blood to the brain and to the rest of the body. His work aims to quickly identify babies who need help and then provide better treatments to make sure they have the best chance of a healthy life.