1st fact

 

Preterm birth is the largest cause of death and disability in children under 5  in developed countries.

2009 Annual Report

Embedded Scribd iPaper - Requires Javascript and Flash Player
Women & Infants Research Foundation
Annual Report 2009
Affiliated with The University of Western Australia and King Edward Memorial Hospital
Friends of the Women & Infants Research Foundation Western Australia
Patron’s Message
It is indeed a privilege to be Patron of the ‘Friends of the Women & Infants Research Foundation’ in Western Australia. I have great pleasure in congratulating them in the 10th year of the Café and Gift Shop, and wish them continued success in the activities that have played such a vital role in assisting the Foundation in its important research work. The work of the Friends really is a wonderful example of serving the community - a service that is selfless and inspiring to all of us. They provide friendship and kindness where it is needed, a helping hand for many and hours of effort to improve the lives of others. I am pleased to be able to recognise the dedication and commitment of the staff and volunteers for their extraordinary contributions. Once again, let me congratulate you all on the achievements over 10 years towards research to improve the health of women and infants in the community. My best wishes for your continued success.
Mrs Julie Michael Patron
Honorary Life Members
Mrs Janet Holmes à Court Mr John Rawlinson Emeritus Professor Con Michael
Women & Infants Research Foundation Western Australia
Carson House King Edward Memorial Hospital 374 Bagot Road Subiaco Western Australia 6008 Postal address PO Box 134 Subiaco Western Australia 6904 Telephone (08) 6458 1437 Facsimile (08) 6458 1642 Website www.wirf.com.au Email info@wirf.com.au
pursuing
Our Mission
TO CONDUCT, SUPPORT AND PROMOTE HIGH QUALITY RESEARCH
quality research for human health
FOR THE BENEFIT OF HUMAN HEALTH RELATING TO THE FIELDS OF REPRODUCTIVE HEALTH AND DISEASES OF WOMEN AT ALL AGES, AND HEALTH AND DISEASE OF EARLY LIFE AND THEIR INFLUENCE ON SUBSEQUENT HEALTH AND DISEASE IN LATER LIFE.
Contents
Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Prime Areas of Research, Organisational Chart . . . . . . . . . .2 Board of Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Chairperson’s Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Executive Director’s Report . . . . . . . . . . . . . . . . . . . . . . . . . .5 Governance Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Grant Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 The Professor Gordon King Scholarships . . . . . . . . . . . . . . .9 Research Units Biostatistics and Research Design Unit . . . . . . . . . . . . . . . . . . .11 The Lotteries Commission / Women and Infants Research Foundation Perinatal Research Laboratories . . . . . .12 Women and Infants Research Foundation / UWA School of Women’s and Infants’ Health Research Laboratories . . . . . .13 Perron Rotary Express Milk Bank . . . . . . . . . . . . . . . . . . . . . . .15 Research Reports The Smile Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Raine “Challenge Me Study” . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Prediction and Prevention of Pre-term Labour using Molecular Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Placental Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Fetal Futures Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Fetal Futures Program - A Retrospective Study . . . . . . . . . . .25 Maternity Care for Rural and Remote Aboriginal Women in WA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Anaesthesia and Pain Relief . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Nutrition for the Newborn Probiotics And NeonaTes Study . . . . . . . . . . . . . . . . . . . . . .29 PeaNut Trial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Intravenous Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Impact of Caffeine and Maturation on Respiratory Control in Preterm Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Mental Health during Pregnancy and the Postnatal Period . . . . .33 Australian Ovarian Cancer Study (AOCS) . . . . . . . . . . . . . . . .34 Laparoscopic Approach to Carcinoma of the Endometrium (LACE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Neonatal Respiratory Medicine and Physiology . . . . . . . . . . .37 Breastfeeding Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 The Fetal and Childhood Origins of Polycystic Ovary Syndrome (PCOS) . . . . . . . . . . . . . . . . . . . . .40 Vaginal Oestrogen Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 Mechanisms of Irregular Bleeding with Implanon Contraceptive Implants . . . . . . . . . . . . . . . . . . . . . . .42 Menopause Symptoms After Cancer (MSAC) . . . . . . . . . . . . .43 Substance Use in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 Family Vascular Risk Factors in the Prediction of Pre-eclampsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Evaluation of Preliminary Forensic Specimen Kits in Recent Sexual Assault . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 Our Heartfelt Thanks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 Research Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 Financial Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
Specific Objectives
• • • • To conduct and support research reflecting the Foundation’s mission. To inform and educate the scientific and wider community of the results and implications of such research. To develop a sustainable funding and relationship management strategy to support the Foundation’s mission. To strengthen the Foundation’s collaborative partnerships with the King Edward Memorial Hospital campus, the UWA School of Women’s and Infants’ Health and other research partners within the wider research community. To foster research excellence from new and established investigators working towards the Foundation’s mission. To enhance the research reputation and standing of the Foundation by raising its profile across the scientific and wider community.
Prime Areas of Research
• • • • • • • • • • • • Fetal origins of adult and childhood diseases Preterm birth: inflammation, infection and prediction The placenta in healthy and complicated pregnancies Improving maternity healthcare delivery Anaesthesia and pain relief in pregnancy Health and nutrition of the newborn Fetal and neonatal heart and lung function Prediction of pre-eclampsia Contraceptives and menstrual bleeding abnormalities Teenage pregnancy and contraception Drug use in pregnancy Menopause and breast cancer
• •
Organisational Chart
Board of Management
Executive Director
Investment Committee
Scientific Grants Committee
Deputy Director
Finance
Marketing and Development Administration Assistant
Annual Research Grants Scheme
Biostatistics and Research Design Unit Volunteers Core Clinical Research Staff Cafe and Gift Shop Baby Photography
Lotteries Commission Perinatal Research Laboratories (UWA Campus)
Women and Infants Research Foundation / The University of Western Australia Laboratories
Breastfeeding Centre
women and infants research foundation
2
Board of Management
Chairperson
Ms Anne Payne Solicitor
Anne Payne
Alan Good
Deputy Chairperson and Treasurer
Mr Alan Good Chartered Accountant
Executive Director
Winthrop Professor John Newnham Professor, Maternal Fetal Medicine King Edward Memorial Hospital Head, School of Women’s and Infants’ Health Deputy Dean, Faculty of Medicine, Dentistry and Health Sciences The University of Western Australia
John Newnham
Ms Andrea Burns Journalist Mr Graeme Boardley Executive Director of Midwifery and Nursing King Edward Memorial Hospital Mr Jim Davies Managing Director Marketing Mrs Nicola Forrest Company Director Winthrop Professor Peter Hartmann Professor of Biochemistry The University of Western Australia Chairman, Scientific Grants Committee Women and Infants Research Foundation Mr Peter Hawkins Company Director Mr Gerald Major Property Consultant Associate Professor Craig Pennell School of Women’s and Infants’ Health The University of Western Australia Certified Subspecialist in Maternal Fetal Medicine King Edward Memorial Hospital Ms Jann Rowley Artist Professor Jane Pillow School of Women's and Infants' Health, The University of Western Australia Viertel Senior Medical Research Fellow Consultant Neonatologist, Women's and Newborns' Health Service
Andrea Burns
Graeme Boardley
Jim Davies
Nicola Forrest
Peter Hartmann
Peter Hawkins
Gerald Major
Craig Pennell
Jann Rowley
Jane Pillow
3
annual report 2009
Chairperson’s Report
elcome to the 2008-9 Report of the Women and Infants Research Foundation.The Board is proud to present this Report outlining the structure of the organisation and its achievements over the year.
W
The Foundation plays an important role in the annual life of Western Australia. It is the sole organisation in the State dedicated to fostering and supporting research in the many fields of women’s health and reproduction.The Board supports activities extending across a wide spectrum from independent clinical and laboratory research, to educational activities, to businesses that provide a service to patients and staff, and to investments and fund-raising. Our goal is to make scientific discoveries that will improve health care. One vital ingredient is to identify and nourish early career researchers, and helping them to achieve in science is one of our core businesses. This year has been particularly challenging as a result of the global financial crisis. All organisations that have substantial investment portfolios have been affected, and we were no exception. We have been fortunate however to have multiple sources of income and we have benefited from our diversified portfolio of investments and profit-making businesses. Our Investment Committee, chaired by Mr Alan Good steered the Board through these challenges and we remain in a solid financial position. Our financial position has also been helped by the outstanding contributions of our volunteers. In May we held our 10-year celebration of the Volunteer Group who assist in the Café and Gift Shop, at Government House, and details of this wonderful day are included in the Report. I would in particular like to thank Mrs Anne-Marie Weekes who heads our Cafe and Gift Shop, which continues to offer so much to the hospital and its people.The Board is also grateful to the many community groups that partner the Foundation, including Channel 7 Telethon and the Lions District 201W1. Many individuals donate to the Foundation, some of whom choose to remain anonymous. The Foundation is an organisation that relies heavily on volunteers. Our Board members, Executive Director and most of the workers in our businesses are volunteers.That the organisation is such a success is testimony to the community spirit and dedication of so many people. I personally extend my grateful appreciation to the Board members who give so much of their time and expertise. It is with sadness that we note the recent passing of Mr Rod Maslin, who for many years served as a member of the Board. On behalf of the Board, I would like to extend our appreciation to the leaders - Winthrop Professor John Newnham who is our Executive Director, Associate Professor Dorota Doherty who is Deputy Director, Professor Jeffrey Keelan and Dr Graeme Polglase who head our Laboratories, Mrs Tina Williams who is our Marketing and Development Manager, Mrs Andrea Cole who is our senior accountant, Mrs Chris Spencer who is the Foundation’s secretary, and the many other clinicians and scientists whose work is so vital to the health of our community.
Anne Payne
Chairperson
women and infants research foundation
4
Executive Director’s Report
he Women and Infants Research Foundation continues to thrive and prosper, producing high quality research that is of direct benefit to the health care of women and babies in Western Australia and elsewhere.This ongoing success results from the hard work of the Foundation’s many employees and volunteers.Together, we share a common aim of creating knowledge that can be translated into improved health care. Coupled with research achievements is a philosophy of providing services for our patients, hospital and staff that also raise funds to be returned in the form of support for research and education.The various activities that together achieve these goals during 2008-9 are reviewed in this Report. I trust you will find them both informative and enjoyable to read.
T
The research priorities are strategically aimed at overcoming the major health care issues in the fields known medically as obstetrics, gynaecology and newborn medicine. Preterm birth remains the single greatest problem in reproduction in the developed world as a whole, and in our own community. Research discoveries by this organisation and others have substantially improved the care and safety of women and babies before and after early birth, but how to prevent prematurity remains elusive. During the year, the Foundation’s research team completed one of the largest controlled medical trials ever conducted in Western Australia aiming to discover if treatment of gum disease in the mother will reduce the chance of early birth. This project is known as the Smile Study and is described in this Report. Future studies are focussed on finding ways to diagnose and treat chronic sub-clinical infections in the uterus which we now believe are likely to be the cause of many of the unexpected early preterm births, and how we can use genetic analyses to identify those women most at risk. King Edward Memorial Hospital has the largest neonatal intensive care unit in Australia, made possible in this State by the concentration of many of our health resources onto a single campus.The number of premature babies arriving in the unit is continuing to increase and much of our research focus aims to find ways to make their health care even safer. Over the last three decades, rates of survival have improved dramatically, but we now need to find better ways to prevent some of the major complications that can result in life-long disability. Studies in progress address strategies to rapidly mature the baby in the hours before birth, find better ways to provide respiratory support without risking injury to their fragile lungs, provide nutrition without damaging the bowel, and strengthen the infant’s immune system so that it may resist the many potential infections that challenge it as it grows into our world of bacteria and viruses. The Foundation is particularly proud of its longstanding record in supporting research into breastfeeding. On site is the Western Australian Breastfeeding Centre, the establishment of which was funded by a joint partnership between the Hospital and the Foundation. Many discoveries have arisen from the initiative, and thousands of Western Australian women and their babies have benefited from the clinical care offered by the Centre.The project was initiated and headed by Professor Peter Hartmann, building on a longstanding career in this field on the campus of The University of Western Australia.This year, Professor Hartmann and his colleague Professor Robin Owens were awarded the International Rank Prize by The Royal College of Physicians, London, UK, in acknowledgement of their lifelong contributions to research in the field.This award is fitting acknowledgment of their world-leading status in the field. Professor Hartmann is Chair of the Foundation’s Scientific Grants Committee and we are proud to have a scientist of such international acclaim at the head of our peer-review process. The Foundation is also active in many other fields of women’s health and reproduction including pain relief, mental health and menopause. A medical research organisation is only as good as its scientists, and its future is only as good as its early career researchers.The Foundation champions future talent and has a multi-tiered support structure to foster the next generation of scientists in this field. Acting on recommendations from the Grants Committee, the Board offers PhD scholarships; top-up grants for individuals who have been awarded a scholarship from elsewhere; Starter Grants to enable new researchers to establish their careers; and Capacity Building Grants to provide substantial support to promising researchers to assist them in attracting major funds from national agencies. We also provide prizes in partnership with other organisations including the Australian Society for Medical Research, the Students in Health and Medical Research Conference (SHMRC); and the Endocrine Society and Reproductive Biology Society of WA.
5
annual report 2009
Executive Director’s Report contd...
This year, the Board announced new Scholarships in honour of Professor Gordon King. Professor King was the first Professor of Obstetrics and Gynaecology at The University of Western Australia, and was also the inaugural Dean of the Medical School from 1957 to 1965. He had a most remarkable career, summarised within this Report.Two separate types of Scholarship have been created - the King Scholarships to support outstanding PhD students and the Professor Gordon King Scholarships for medical and science students who wish to spend one year working on research into women’s health and reproduction within the Bachelor of Medical Science program. In April 2009 we celebrated the 10-year anniversary of our Volunteer Program.The Cafe and Gift Shop was opened in April 1999 staffed by volunteers and supported by a small number of paid staff. Over the decade, the business has made more than $2.59m from a turnover of $10.35m, all of which has been distributed for research. On May 5th 2009, a formal ceremony was held at Government House hosted by the Governor of Western Australia, His Excellency Dr Ken Michael, and Mrs Julie Michael. We are proud and grateful to have Mrs Michael as Patron of The Friends of WIRF.The event was an outstanding success and gave due recognition to the many wonderful people who provide such selfless and dedicated support to our organisation. One of the major achievements of the Foundation during the previous year was to host the 5th World Congress of the Society of the Developmental Origins of Health and Disease (DOHaD).This Society brings together the many clinicians, scientists and others who are addressing the world-wide epidemic of obesity, diabetes, heart disease and related conditions by unravelling the role of events before and soon after birth.The Congress was held at the Perth Convention and Exhibition Centre from November 6-10th 2007.The Congress won the 2008 Western Australian Meeting of the Year, More than 500 Delegates Award. The Foundation continues to value its many partnerships and we thank the individuals in the organisations whose support we enjoy. In particular we are grateful to King Edward Memorial Hospital and its Executive;The University of Western Australia and the Faculty of Medicine, Dentistry and Health Sciences; Channel 7 Telethon and Lions District 201W1. I would like to personally thank the many researchers and staff who make working with this Foundation such a valuable and pleasurable experience. Each of the divisions is headed by effective leaders ensuring productivity and efficiency. Grateful appreciation is extended to Assoc. Professor Dorota Doherty who heads the Biostatistics and Research Support Unit; Professor Jeffrey Keelan who heads the WIRF/UWA Laboratories; Dr Graeme Polglase who heads the Perinatal Research Laboratories located on the UWA Crawley campus; Dr Ben Hartmann who leads the Human Milk Bank; Mrs Anne-Marie Weekes who heads the Cafe and Gift Shop; Ms Julie Rutgers who heads the First Photo Business; Mrs Tina Williams, our Marketing Manager; Mrs Andrea Cole our accountant; and Mrs Christine Spencer who is the Foundation’s secretary. I would also like to acknowledge the wonderful support that we receive in information technology from Mr Tony Smith from the UWA Faculty of Medicine, Dentistry and Health Sciences. Finally, I thank Ms Anne Payne for her clear direction and commitment as Chair of the Board, Mr Alan Good as Deputy Chair, and each of the Board members for their leadership and support during the year. At the present time, our health care system is challenged by increasing numbers and complexity of clinical cases.The Foundation is playing a vital role in providing high quality research and education to help meet these challenges. Many initiatives are in development that will ensure that in the coming years our organisation can look forward to making even greater contributions to women’s health and reproduction.
Winthrop Professor John Newnham
Executive Director
Andrea Cole
Christine Spencer
Claire Williams
Anne-Marie Weekes
Julie Rutgers
Tina Williams
Tony Smith
Dawn Masilamony
women and infants research foundation
6
Governance Statement
Board of Directors
The Board of Management provides strategic direction to Foundation management to ensure the quality, efficiency and longevity of our research, clinical and community activities.The Board meets six times each year, all Board Members serve on a voluntary basis.
Corporate and Research Ethics
All employees are expected to discharge their duties in good faith and act honestly in the best interest of the Foundation, striving at all times to enhance the reputation and performance of the Foundation. All scientific studies conducted by the Foundation are approved by the Ethics Committee of the Women and Newborn’s Health Service and/or the Human Research Ethics Committee and Animal Ethics Committee of The University of Western Australia.
Scientific Grants Committee
The Committee is chaired by Winthrop Professor Peter Hartmann, Professor of Biochemistry and previously Dean of the Faculty of Science at The University of Western Australia. Members of this Committee are appointed by the Board on an honourary basis. Half of the members of the Committee are employed externally to the KEMH campus.The Committee meets to consider research applications for financial support and advises the Board on suitability for funding.The Committee also provides the Board with advice on scientific matters as required. Specifically they review applications for Starter Grants, Capacity Building Grants and PhD Scholarships.
Risk Management
All employees and volunteers of the Foundation undergo criminal screening and blood tests in compliance with the requirement of the Women and Newborn’s Health Service, irrespective of whether they have direct contact with WNHS children or not.
Chairperson
Winthrop Professor Peter Hartmann Professor of Biochemistry The University of Western Australia
Financial Reporting
The Foundation’s financial year ended on June 30th 2009. Our Chairperson and Treasurer jointly signed off on the Annual Financial Reporting process on behalf of the Board. A copy of the Foundation’s financial reports for year end June 30th 2009 are available on www.wirf.com.au
Committee
Winthrop Professor John Newnham Professor, Maternal Fetal Medicine Executive Director, Women and Infants Research Foundation Head, School of Women’s and Infants’ Health The University of Western Australia Winthrop Professor Brendan Waddell Head, School of Anatomy and Human Biology The University of Western Australia Professor Jane Pillow School of Women's and Infants' Health Neonatal Consultant King Edward Memorial Hospital Dr Daniela Ulgiati Lecturer Biochemistry and Molecular Biology The University of Western Australia Dr Katherine Sanders School of Anatomy and Human Biology The University of Western Australia
Audit Governance
The Foundation engages W H K Horwath as an external audit team to independently review its financial reports and uphold the integrity of the reporting process.
Not for Profit Status
The Foundation operates as an incorporated not for profit organisation.The Australian Taxation Office has endorsed the Foundation as an Income Tax Exempt Charitable Entity and a Deductible Gift Recipient. This status ensures that anyone donating to the Foundation can claim the full tax benefit.The Foundation also holds a Charitable Collections Licence from the Department of Consumer and Employment Protection in Western Australia.
7
annual report 2009
Grants Funding
Starter Grant funding by the Foundation - 2008 • “Transmission of Buprenorphine in Breastmilk of Lactating Mothers”
Professor A Bartu, Emeritus Professor K F Ilett, Dr D F Hamilton, Mr S O’Halloran Amount funded: $15,000
Capacity Building Grants funded by the Foundation 2007-2009
In 2006 the Foundation established the Capacity Building Grant funding programme.The Capacity Building Grants are part of a wider strategy designed to nurture and develop promising researchers in line with the Foundation’s mission. The grants provide flexible support to allow investigators to develop their capacity to assist them in attaining a level of productivity and capability sufficient to attract nationally competitive grant funding.The Foundation funds a maximum of two Capacity Building Grants per year. Successful applications reviewed by the Scientific Grants Committee receive $105,000 in funding over three years.
• “Epidural Pethidine after Caesarean Section. A Pilot Study of Initiation of Lactation, Plasma and Milk Levels of Pethidine and Norpethidine and the Behaviour of Breast-fed Infants (The EPACS Study)”
Dr Y Al-Tamimi,Winthrop Professor M J Paech,Winthrop Professor P E Hartmann Amount funded: $15,000
In 2007 a Capacity Building Grant was awarded to: • Preterm Birth Genome Project
Associate Prof C E Pennell and Associate Investigator Dr Jennifer Henderson Amount funded: $35,000 per year (funding for three years beginning 2008) Brief Description
The goal of the preterm birth genome project (PGP) consortium is to identify genes that affect susceptibility to Preterm Birth and other adverse pregnancy outcomes associated with preterm birth.This objective will be expedited by combining the resources of multiple research groups from around the world.This venture represents a new approach to the study of the genetics of Preterm Birth, and is intended to provide adequate research resources that will enable the discovery of important genes that would otherwise be difficult, if not impossible. The WIRF Preterm Birth Genome Project Capacity Building Grant is currently being used to collect a Western Australian cohort of 1000 maternal and fetal cases of spontaneous preterm birth and 1000 matched maternal and fetal controls to be utilised in the Preterm Birth Genome Project in conjunction with similar samples from Mexico, Korea, Canada, the United States and Africa.
• “Isolation and propagation of mammary epithelial stem cells from human breastmilk”
Dr T R Martin, Dr M D Cregan Amount funded: $13,035
• “Development of a rapid method for the detection of unacceptably high bacterial content in donor human breast milk utilising a simple gram stain of bacteria retained on a polysulphone membrane”
Dr B T Hartmann Amount funded: $11,668
• “Evaluation of Preliminary Forensic Specimen Kits in recent sexual assault”
Dr M A Phillips, Dr D A Smith, Dr C H Nixon Amount funded: $8,113
• “Epigenetic Influences on Child Health and Development in the Raine Study”
Dr R-C Huang, Dr J A M Van Eekelen, Associate Prof C E Pennell,Winthrop Professor L J Beilin Amount funded: $15,000
• Understanding ventilation of the preterm lung and implications for long term respiratory well-being
Prof Jane Pillow Amount funded: $35,000 per year Brief Description
This capacity building grant focused on providing support for research studies that aimed to improve our understanding about how to optimally inflate the lung and achieve good gas exchange without causing injury in the preterm infant with breathing difficulties after birth. We also aimed to increase our understanding about the growth and development of the lung after birth, and how it relates to preterm birth and the severity of initial lung disease. The flexibility of this grant has facilitated the establishment and continuation of a highly productive and intensive research program: 8 out of 17 manuscripts published by the CI over the last three years have directly benefited from funding arising from this capacity building grant.The increase in productivity assisted by this grant has substantially enhanced our understanding of the causes and consequences of lung disease in premature infants, and has contributed to success in 2009 in obtaining NIH and NHMRC funding to continue this work.
(funding for three years beginning 2006)
women and infants research foundation
8
PhD Scholarships (Top up funded) • Effect of milk composition and milk volume on gastric emptying in the preterm infant
Sharon Perrella Amount funded: $6,250 per annum (beginning 2009) for six years (half time) with a one-off $3000 consumables and travel allowance
• Mechanisms of Gas Exchange and Ventilation Perfusion during High Frequency Jet Ventilation
Dr Gabby Musk Amount Funded: $4,000
• Effects of antenatal supplementation with long chain polyunsaturated fatty acids on the development of intentionality and communication
Suzanne Meldrum Amount funded: $10,000
(2007, 2008, 2009) + $2,000 travel allowance
• The ABC of placental cell differentiation and death
Ambika Singh Amount funded: $10,000
(2007, 2008) + $2,000 travel allowance
• The Role of ABC Lipid Transporters in Placental Differentiation and Function
Irving Aye Amount funded: $10,000
(2007, 2008, 2009) + $2,000 travel allowance
The Professor Gordon King Scholarships
This year the Foundation introduced a new range of scholarships named in honour of Professor Gordon King. Professor Gordon King was the inaugural Dean of the Medical School of The University of Western Australia and the first Professor of Obstetrics and Gynaecology. He had an amazing journey to these positions. Born in England, he trained in medicine in London then travelled to China and Hong Kong. By the time of the Japanese invasion of Hong Kong in 1941, he was Head of Obstetrics and Gynaecology at the University of Hong Kong. He escaped north into free China, west of that part of the country occupied by the Japanese. Many of his previous medical students also escaped north, heading for their teacher. From a hospital in Chungking, he organised the training of more that 350 students, including 141 medical students. Chungking is now called Chongqing and is in Sichuan province. He managed to gain appropriate recognition for the training of these students and nearly 60 of them returned to Hong Kong after the war as medical practitioners. Professor King also returned to Hong Kong where he resumed his position as Professor of Obstetrics and Gynaecology. In 1956 Professor Gordon King was recruited by Sir Stanley Prescott, then Professor Gordon King Vice-Chancellor of The University of Western Australia, to move to Perth to head up the new medical school as Dean. He held this position until his retirement in 1965. Professor King is survived by three daughters, one of whom, Allison Kennedy, is married to Justice Geoffrey Kennedy, past Chancellor of The University of Western Australia. The Foundation has created two types of Scholarships. First are the King Scholarships which are for PhD students of the highest calibre and will provide a stipend and support at the same high level as the most prestigious scholarships offered by The University. Second are the Professor Gordon King Scholarships which are for medical students who interrupt their clinical training for one year to pursue research, achieving a Bachelor of Medical Science (B Med Sci). The inaugural recipient of a Professor Gordon King Scholarship is Mr Owen McWilliam. Owen’s research is attempting to identify a link between preterm birth, caused by preterm prelabour rupture of membranes, and genetic variations in maternal and fetal DNA. Amount funded: $6,000.
Owen McWilliam
9
annual report 2009
women and infants research foundation
10
image courtesy of Sunday Times
Biostatistics and Research Design Unit
Overview of Research
The Biostatistics and Research Design Unit provides statistical collaboration and consultation in the design, conduct, analysis, interpretation, and reporting of research studies conducted by investigators at King Edward Memorial Hospital and affiliated institutions. Our main activities involve study design, data collection methods, data analysis of completed studies, manuscript preparation, grant proposal preparation, conduct of independent interim analyses for clinical trials, review of grants and manuscripts, presentation of seminars on statistical methods in medical research, and student supervision. Our involvement in a new study often begins by consulting with investigators to understand the study objectives, and to select the appropriate study design and associated statistical methods to answer a given clinical question. Selection of the appropriate statistical methods may also require the development of computational algorithms to meet the needs that are project specific. A short-term statistical consultation may only require one or two sessions on designing experiments, initial planning for data collection, giving advice on statistical methodology for data analysis, or performing data analysis of a completed study. Investigators are encouraged to obtain statistical advice for their research at any stage of their project and consequently short-term consultations often develop into ongoing longer term collaborations. The majority of our activities involve ongoing, long term collaborations on research studies that begin at a study
RESEARCH UNITS
conception and continue until its completion and dissemination of results. We are often involved in grant proposal writing which includes the formulation of primary and secondary objectives, hypothesis formulation and testing, sample size estimation, planning for study monitoring and inclusion of interim analyses. While designing a study, we always consider the effects of potential major confounding variables because such confounders may affect study outcomes even when they are not directly related to the outcome of interest. In the research studies where the outcomes investigated are expected to differ in distinct patient groups, we consider whether a stratification of participants is required. We are often involved in all aspects of data collection and management including advice on outcomes measurement, design of data collection forms, assistance and advice on database construction and management. In randomised research studies we facilitate blinding of principal investigators whenever possible by preparing randomisation schedules. We contribute to the dissemination of study results by performing analysis of completed studies and preparing statistical reports and contributing to the writing of research manuscripts. Our main aim is to support and increase the level and effectiveness of biostatistics in research conducted on the campus and we look forward to meeting new challenges in women’s health and reproduction in the coming year.
Associate Professor (Adj) Dorota Doherty
Head
L-R: James Humphreys, Dorota Doherty, Angela Jacques, Liz Nathan
11
annual report 2009
RESEARCH UNITS The Lotteries Commission/Women & Infants Research Foundation Perinatal Research Laboratories Overview of Research
Staff and students based at the WIRF Perinatal Research Laboratories are involved in research studies including investigations into: the developmental origins of health and disease; fetal responses to intrauterine inflammation and its effects on development of the fetal brain and lungs; studies of new ventilation techniques aimed at improving chances of survival and wellbeing of preterm infants; interactions between ventilation and cardiovascular and pulmonary blood flows; and fundamental aspects of fetal development. Financial support for these projects has been awarded from several local, national and international competitive granting bodies, including the Women and Infants Research Foundation,The National Health and Medical Research Council (Australia),The National Heart Foundation of Australia,The Sylvia and Charles Viertel Charitable Foundation and The National Institutes of Health (USA). We also receive significant contributions from our commercial partners/collaborators including Fisher and Paykel Healthcare, Bunnell Inspired Infant Care Incorporated and Chiesi Pharmaceuticals.The budget for projects conducted within the WIRF Perinatal Research Laboratories is sourced entirely from externally funded research grants. An ongoing commitment by WIRF to provide financial and infrastructural support for the running of the laboratories ensures that research grants are dedicated to funding only experimental work. Our research collaborations, excellent laboratory facilities, support from WIRF, and the dedication of researchers working within the Laboratories, will ensure that we continue our valuable contributions to improving the lives of people around the world. The facilities and support provided by WIRF have expanded the research capabilities of the Foundation and The University of Western Australia, and have contributed to the recruitment of research scientists and clinicians from Australia and overseas. We have expanded our research team this year with the recruitment of Dr Matthew Kemp, a research fellow who has recently completed a postdoctorate position at Oxford University, and Dr Masatoshi Saito, an obstetrician from Japan, who are both working on our sheep program in collaboration with our colleagues from the USA. We wish them both every success in their research. Finally I would like to thank WIRF and everyone at the UWA school for their fantastic support and direction over the past five years. My wife (Penny Rowlett) and I have made the difficult decision to move back to Melbourne so our young children can be closer to our family. I have thoroughly enjoyed my role as Manager of the Perinatal Research Laboratories since 2006, and will always cherish the friendships I have made during my time in Western Australia.
Dr Graeme Polglase
Manager
Researchers
WIRF/School of Women’s and Infants’ Health,The University of Western Australia Winthrop Professor John P Newnham MD FRANZCOG Professor Jane Pillow FRACP PhD Dr Ilias Nitsos BSc (Hons) PhD Dr Graeme Polglase BSc (Hons) PhD Dr Matt Kemp BMLSc PgDipMLSc PhD Dr Masatoshi Saito MD PhD Carryn McLean BSc (Hons) Research Assistant Richard Dalton BSc Research Assistant Andrea Lee BSc (Hons) PhD Candidate Dr Gabby Musk BSc BVMS Cert VA Dipl ECVAA MRCVS PhD Candidate Melanie Slater BMedSc Honours Candidate Cincinnati Children’s Hospital Medical Center Professor Alan H Jobe MD PhD Dr Suhas G Kallapur MD Dr Noah Hillman MD University Hospital Maastricht,The Netherlands Dr Boris W Kramer MD Monash University Associate Professor Stuart B Hooper BSc (Hons) PhD Dr Beth Allison, BSc (Hons) PhD Royal North Shore Hospital Dr Martin Kluckow MBBS PhD Queensland Institute of Technology Dr Christine Knox PhD
women and infants research foundation
12
RESEARCH UNITS Women & Infants Research Foundation/UWA School of Women’s and Infants’ Health Research Laboratories Overview of Research
The Women’s and Infants’ Health Research Laboratories (WIHRL) are jointly owned and managed by the Foundation and The University of Western Australia (UWA) School of Women’s and Infants’ Health.The laboratories are located on the second floor of King Edward Memorial Hospital.Within the laboratories are separate suites for RNA, DNA, image analysis and tissue culture, a large general biomedical laboratory and freezer storage facilities. The purpose of the laboratories is to complement and enhance both clinical and basic research undertaken through the Foundation and University, as well as to provide analytical facilities for research conducted in the Perinatal Laboratories on the UWA campus in Crawley.The laboratories currently support the research of four Professors, one Associate Professor, three Postdoctoral Fellows, five Research Assistants and three Research Midwives.The School also has four PhD, three BMedSci Honours students and two 4th year medical students with laboratory-associated projects.The Laboratories are headed by Professor Jeff Keelan and managed by Mr Shaofu Li. Several years ago, the Lions Image Analysis Suite was established in the laboratory using funds generously donated by the Lions Club (WA). This year, the facility was enhanced through the acquisition of a Nikon inverted fluorescent microscope to allow the visualisation and imaging of cultured cells and tissues. Funds to purchase this instrument came from a grant from the Raine Foundation.The Lions this year continued their support for the Laboratories by donating a considerable sum which was used to fund the purchase a microtitre plate reader/analyser.This is a vital piece of equipment that is used to measure hormones, enzymes and related molecules present in blood and fluids at very low concentrations, and is key to many of the projects currently under way in the laboratories.
Professor Jeff Keelan
Head
key highlights
• Expansion of our Image Analysis Suite with the arrival of a new inverted fluorescent microscope and digital camera for the imaging of cultured cells and tissues. Establishment of an extraction and solvent evaporation facility for the isolation and analysis of drugs, lipids and other fat-soluble compounds from biological fluids. Expansion of freezer facilities with the acquisition and furnishing of a second ultra-low temperature freezer room. Funding for the acquisition and running of an automated DNA extraction platform (late 2009).

• •
13
annual report 2009
women and infants research foundation
14
Human Milk Bank – Perron Rotary Express Milk (PREM) Bank
Overview
On 5th July 2006 the PREM Bank, Australia’s first donor human milk bank, began dispensing Pasteurised Donor Human Milk (PDHM) to extremely preterm infants whose own mothers were unable to provide sufficient breastmilk for their needs. Grading these babies, born as much as four months early and weighing as little as 400g, from intravenous nutrition to milk feeds is one of the major challenges that Neonatal Intensive Care Unit doctors face. The immature gut is prone to complications such as necrotising enterocolitis (NEC or ‘gangrene of the gut’) which is 6-10 times more common in preterm infants fed artificial formula compared with those fed breastmilk. Over 50% of babies with confirmed NEC require surgery, which may involve the removal of large sections of dead and dying bowel tissue. Of these, half will not survive.Thus it is essential mothers provide their own breastmilk. Unfortunately, many mothers who give birth prematurely struggle to provide sufficient breastmilk for their babies and a safer alternative to preterm artificial formula is required.
RESEARCH REPORTS
The PREM Bank was established through collaboration between the Neonatal Intensive Care Units at King Edward Memorial and Princess Margaret Hospitals,The University of Western Australia and the Women and Infants Research Foundation. In the first three years of operation over 1000 litres of donor milk have been dispensed to hospitalised infants at King Edward and Princess Margaret Hospitals. Through the development and publication of Best Practice Guidelines for human milk banking and invited presentations at international conferences, the PREM Bank has already gained a significant reputation as a leader in the safe operation of donor human milk banks both in Australia and internationally. Research is conducted in the following areas: collection methods to reduce contamination; microbiological screening techniques to readily identify potential pathogens in milk and thus minimise amount of pasteurised milk discarded and improved pasteurisation methods to preserve all bioactive substances (benefits) in donated breastmilk.
Dr Ben Hartmann
Manager (Scientist-in-Charge)
key highlights
• • Commissioned a 9 litre human milk pasteuriser in June 2009 to meet increasing demand for donor milk in WA. The PREM Bank, in its 3rd year of operation, dispensed 590 litres of donor milk - an increase of 227% on the previous year. The PREM Bank provided donor milk to over 180 hospitalised infants. The PREM Bank was awarded a 2008 Premiers Awards for Excellence in Public Sector Management (in the category “Creating a Healthy, Safe and Vibrant Western Australia). Dr Hartmann completed a consultancy with UNICEF (Philippines) to assess and assist with the development of National Guidelines for the operation of two recently established milk banks in the Philippines.
• •

L-R: Amanda Peacock, Ben Hartmann, Tracey Sedqwick
15
annual report 2009
The Smile Study:
This year saw the conclusion of the Smile Study.This study was one of the largest randomised controlled trials to have been performed in Western Australia. Preterm birth remains the single greatest problem in reproduction in our community. In Australia, more than 8% of all births end prematurely and the percentage is rising. Research conducted by ourselves and others has shown that most of the pregnancies that result in very early birth have been affected by inflammation within the pregnant uterus. Often we can find evidence of infection that may be causing the inflammation, but in many cases there is no sign of bacteria in the baby or the uterus.These findings have raised the possibility that the source of the inflammation may be elsewhere.The mother’s mouth has been a very attractive site for us to seek answers. About 15% of pregnant women in our community have periodontal (gum) disease. For some women the disease is expressed as bleeding gums during eating or tooth-brushing, for some there is pain on biting, and for many there are no symptoms at all. Studies in our laboratory and others have provided very plausible evidence that the products of inflammation in the mother’s gums may enter the circulation, travel to the pregnant uterus, and initiate labour. In order to definitively answer the question of whether preterm birth may be prevented by treating periodontal
RESEARCH REPORTS
Preventing preterm birth by treating periodontal disease during pregnancy
disease, we conducted a large randomised study.The study was conducted across seven sites in metropolitan Perth – King Edward Memorial Hospital, the Oral Health Centre of Western Australia, Osborne Park Hospital, Swan Districts Hospital, Armadale Hospital, Rockingham Hospital and Joondalup Hospital. 3737 pregnant women with a history suggesting a risk of periodontal disease were examined by one of the study hygienists. 1082 of these women were found to periodontal disease. Each woman was then allocated at random to receive full periodontal treatment commencing around 20 weeks gestation (542) or treatment six weeks after the pregnancy was completed (540).The treatment was conducted at three weekly visits, with further visits if required. The conduct of this trial was highly successful, with completion almost on-time and almost on-budget.This success is testimony to the research structure that is in place at the Women and Infants Health Foundation, the skill and dedication of the research staff, and most importantly, the commitment of the many thousands of Western Australian women who participated. The results of the study are in press in the journal Obstetrics and Gynaecology. Results cannot be released until the date of publication, expected to occur in late 2009.
John Newnham
Dorota Doherty
Craig Pennell
Antonia Shand
Jonathon Swain
Ian Newnham
women and infants research foundation
16
image courtesy of The West Australian
Chief Investigators
WIRF/UWA Winthrop Professor John Newnham MD FRANZCOG Associate Professor (Adj) Dorota Doherty B Sc (Hons) PhD Associate Professor Craig Pennell MBBS (Hons) PhD UWA School of Dentistry/Oral Health Centre of Western Australia Dr Ian Newnham MDSc FRACDS (Perio) Dr Jonathon Swain BDSc MDSc Professor John McGeachie BDSc PhD DSc
Dental Hygienists
Michelle Wright Assoc Degree Dental Hygiene Esther Jansen Assoc Degree Dental Hygiene Belinda Orrock Assoc Degree Dental Hygiene Dagmar Toman Assoc Degree Dental Hygiene Lyn Patrick Assoc Degree Dental Hygiene Rhona Brooksbank Assoc Degree Dental Hygiene
Dental Assistant
Lorraine Howard
Research Midwives
Colleen Ball RN RM BN Desiree Cavill RN RM Delores Gasbarro RN RM BSc Nsg Hons Renate McLaurin RN RM BHlth Sc Cherry Young RN RM Melanie Mosey RN RM Sally Bakker RN RM
Major Sponsors
National Health and Medical Research Council (NHMRC) of Australia Colgate-Palmolive Oral-B Channel 7 Telethon Trust
Colleen Ball
Desiree Cavill
Renate McLaurin
Cherry Young
Michelle Wright
Esther Jansen
Belinda Orrock
17
annual report 2009
Raine “Challenge Me Study”
Overview
The Raine “Challenge Me Study” is the largest evaluation of stress induced hypothalamic-pituitary-adrenal axis function ever conducted in the world.We have already completed more than 800 assessments with another 700 planned in the next 18 months. The environment of mother, infant and child are key contributors to diseases and conditions that represent some of today’s most important global public health issues. This study provides a unique opportunity to investigate gene:environment interactions within the developing hypothalamicpituitary-adrenal axis that impact on altered endocrine function, growth, behaviour and brain maturation throughout childhood and adolescence. The Raine Study began in 1989 at King Edward Memorial Hospital with recruitment of a cohort of unborn children to determine how events during pregnancy and childhood influence health in later life. Pregnant women were recruited at Carson House and our antenatal clinics between 1989 and 1992 into a randomised controlled trial evaluating the impact of serial ultrasound scans on pregnancy outcome. From this study, 2868 children, the Raine cohort, have been followed closely over the last 18 years by a collaborative team of researchers from The University of Western Australia (Schools of Women’s & Infants’ Health and Medicine & Pharmacology), the Women and Infants Research Foundation, the Telethon Institute for Child Health Research, the Western Australian Institute for Medical Research, Curtin University and the University of Notre Dame.The Raine cohort is one of the largest and most successful prospective cohorts of pregnancy and childhood in the world with detailed longitudinal data on 2868 children and their families throughout pregnancy, childhood and adolescence.
RESEARCH REPORTS
Objectives
The Raine “Challenge Me Study” began in 2008 and over the last 18 months the research team has evaluated more than 800 young adult members of the Raine cohort.This project has been funded by the Canadian Institutes of Health Research and is part of a larger project evaluating gene:environment interactions underlying the developmental origins of health and disease. The “Challenge Me Study” is a psychological challenge, similar to the TV show “Thank God You’re Here”. The exact nature of the challenge is only revealed to the member of the cohort once the challenge begins. This specific challenge utilised by the research team is considered the gold standard challenge of the hypothalamic-pituitary-adrenal axis and the results of this study will allow a detailed evaluation of each individual’s response to psychological stress. The results of this study will be evaluated in a wider context relating to events during intrauterine growth, early life events and development during childhood and adolescence. For the first time, this project has integrated Women and Infant Research Foundation Volunteers into our research program. The involvement of both men and women volunteers has greatly assisted the conduct of this study and the research team is very thankful for their participation.The Challenge Me study will take three years to complete and will become the largest evaluation of stress induced hypothalamic-pituitary-adrenal axis function ever conducted in the world.
women and infants research foundation
18
Chief Investigators
Associate Professor Craig Pennell MBBS(Hons) PhD FRANZCOG CMFM Associate Professor in Maternal Fetal Medicine Scientific Director,The Western Australian Pregnancy Cohort (Raine) Study, The University of Western Australia and the Women and Infants Research Foundation Dr Anke van Eekelen PhD Research Fellow and Adjunct Senior Lecturer Telethon Institute for Child Health Research and Centre for Child Health Research at The University of Western Australia Winthrop Professor John Newnham MD FRANZCOG CMFM DDU Professor of Maternal Fetal Medicine The University of Western Australia and the Women and Infants Research Foundation Professor Stephen Lye PhD Professor, Department of Obstetrics and Gynaecology University of Toronto Associate Director and Vice President Research Samuel Lunenfeld Research Institute, Mt Sinai Hospital,Toronto
L-R: Karen Bosel, Krysia Zarzycki, Hilary Hii, Blagica Penova-Veselinovic
Research Team
Karen Bosel BSc (Hons) Blagica Penova-Veselinovic MSc (Hons) Hilary Hii BSc (Hons) Catherine Coleman BSc (Hons) Krysia Zarzycki RN RM
L-R: Anke van Eekelen, Craig Pennell
John Newnham
Catherine Coleman
Stephen Lye
19
annual report 2009
Prediction and Prevention of Preterm Labour using Molecular Genetics
Overview of Research
The research program investigating the prediction and prevention of preterm labour utilising molecular genetics has three components: 1) the “true” preterm labour study; 2) identifying genetic markers of periodontal disease-associated pre-term birth; and 3) the preterm birth genome project lead by the World Health Organisation.
RESEARCH REPORTS
Highlights and Outcomes
The utilisation of new technologies has provided us with the opportunity to develop a new non-invasive method of accurately and reliably diagnosing true preterm labour. Distinct gene expression profiles in maternal white blood cells appear to predict delivery within 48 hours, delivery less than 34 weeks, and delivery less than 37 weeks gestation The results of this work have culminated in filing North American and worldwide patents on the predictive “genetic signature” for true pre-term labour. Through collaboration with the World Health Organization and the Preterm Birth International Collaborative, the research team is participating in a multinational genome-wide association study of pre-term birth resulting in more than one million dollars worth of genotyping being performed through the WIRF laboratories on samples from four continents. The “true” preterm labour study is investigating the clinical condition of threatened pre-term labour.This condition, where women present to hospital with regular uterine contractions many weeks prior to their expected delivery, occurs in many women during pregnancy and accounts for one third of all antenatal hospital admissions for pregnant women. Fortunately, most women who present with threatened pre-term labour do not progress to pre-term delivery. Each year in Australia more than 120,000 women are admitted to hospital with threatened
pre-term labour, yet only 6000 of these deliver within 7-10 days. Our ability to predict the 5% who will progress to delivery within 7-10 days is poor. Utilising molecular genetics techniques, our research team has identified specific “genetic signatures” that accurately predict delivery within 48 hours, prior to 34 weeks and prior to 37 weeks gestation.These signatures will allow the development of new noninvasive methods of accurately and reliably diagnosing true preterm labour which will provide the means to effectively triage patients and so reduce demands on limited health care resources, to limit the use of existing approaches to those patients whose preterm birth is imminent, and to define targeted patient groups to test new therapeutic approaches to prevent pre-term birth.The success of this project has resulted in further funding ($1M) from the Alberta Heritage Foundation for Medical Research to develop these techniques in an asymptomatic population of pregnant women who are currently being recruited. There is a growing body of evidence suggesting an association between gum disease and pre-term birth; however, potential mechanisms for this association have yet to be established. Utilising the principle that our group discovered in the “true pre-term labour study”, we have been evaluating the effect of treatment of gum disease in pregnant women on patterns of gene activation in white blood cells.These studies will provide a genome wide evaluation of the potential mechanisms responsible for the possible association between gum disease and preterm birth. Further, they may offer novel targets for future treatment opportunities to prevent preterm birth.The completion of the “Smile” study now allows our team to use invaluable samples collected from women in the “Smile” study to rapidly increase our understanding relating to the mechanisms through which periodontal disease is associated with adverse pregnancy outcomes, possibly including stillbirth.
women and infants research foundation
20
With the disclosure of the sequence of the entire human genome and the availability of high-throughput methods making genotyping of large numbers of samples faster and less expensive than ever, our ability to acquire genetic data has increased exponentially. Molecular genetic techniques have demonstrated that approximately one third of the risk of preterm birth is genetic. During 2007 and 2008 a group of international investigators (including members of our research team) has formed the Preterm Birth Genome Project (PGP) Consortium.The PGP is lead by the World Health Organization through collaboration with the Preterm Birth International Collaborative (PREBIC).This consortium has assembled a team of international research leaders, 28,000 DNA samples from women with preterm birth, and successfully obtained $1.5M to begin to unravel the genetic basis of preterm birth. Phase one of this project has been completed in the WIRF laboratories over the last month and has demonstrated that DNA samples can safely be transported around the globe at room temperature without compromising the quality of the DNA. Our team has successfully genotyped DNA from blood and saliva samples from Perth, Denmark, Sweden, Mexico, Korea and Canada with 99.7% accuracy, and is currently well under way genotyping 1200 DNA samples from Perth and Denmark for more than 1 million genetic variants to unravel genetic risk factors for preterm birth.This project has been funded by the World Health Organization, the March of Dimes Birth Defects Foundation, Mexico’s government agency for science (CONACyT) and the Instituto Nacional de Perinatologia in Mexico. In 2009, our research team was successful in obtaining funding from Telethon to collect the next cohort of Western Australian Preterm births for the PGP consortium.This funding will enable the collection of DNA samples from 3000 mothers and their babies who deliver preterm over the next 3 years. Moreover, it has enabled the purchase of robotic equipment to streamline DNA extraction. Through the establishment of a team of committed international researchers, we anticipate making major advances into the genetic basis of preterm birth over the coming years.
Chief Investigators
Associate Professor Craig Pennell MBBS (Hons) PhD FRANZCOG CMFM The University of Western Australia and the Women and Infants Research Foundation Professor Stephen Lye PhD Professor, Department of Obstetrics & Gynaecology, University of Toronto Associate Director and Vice President Research, Samuel Lunenfeld Research Institute Mt. Sinai Hospital Toronto Professor Alan Bocking MD PhD Professor and Chairman, Department of Obstetrics & Gynaecology, University of Toronto Winthrop Professor John Newnham MBBS MD FRANZCOG CMFM DDU Professor of Maternal Fetal Medicine The University of Western Australia and the Women and Infants Research Foundation
Researchers
Dr Jennifer Henderson PhD MPH Grad Dip (Adv Nursing) BSc RN RM Postdoctoral Research Fellow Karen Bosel BSc (Hons) Research Assistant Blagica Penova-Veselinovic BSc (Hons) Research Assistant
Major Sponsors
March of Dimes Birth Defects Foundation World Health Organization Mexico’s government agency for science (CONACyT) Instituto Nacional de Perinatologia in Mexico. Raine Medical Research Foundation PSI Foundation in Ontario Canada Women and Infant Research Foundation Capacity Building Grant Channel 7 Telethon Trust
Craig Pennell
Jennifer Henderson
John Newnham
Stephen Lye
21
annual report 2009
women and infants research foundation
22
Placental Research
Overview
The Placental Research group is headed by Professor Jeff Keelan and is comprised of PhD students Ambika Singh and Irving Aye, Research Assistant Jessica Lewis, Honours student Rebecca Colvin and year IV medical students Kyran Smith and Cameron Hayes. The Placental Research Group currently has three main areas of study: • The causes of placental inflammation, a leading trigger of premature birth, and the use of anti-inflammatory drugs to block inflammation-driven preterm labour. The study of drug transporters in the placenta and their role in a) protecting the fetus from toxins and harmful chemicals, and b) modifying cellular lipids and survival during placental formation. The effects of dietary supplementation with omega-3 fatty acids in pregnancy on placental inflammation and oxidative stress.
RESEARCH REPORTS
Chief Investigators
WIRF/UWA School of Women’s and Infants’ Health Professor Jeffrey Keelan BSc (Hons) MSc PhD MRSNZ UWA School of Anatomy and Human Biology Professor Arunasalam Dharmarajan BSc MSc MMedSci PhD Winthrop Professor Brendan Waddell BSc (Hons) PhD UWA School of Medicine and Pharmacology (Royal Perth Hospital Unit) Dr Trevor Mori BSc (Hons) PhD Liggins Institute, University of Auckland, New Zealand Professor Murray Mitchell DPhil DSc FAIC CChem FRSC FRSNZ School of Veterinary Sciences, St Lucia, Queensland Dr Phillip S Bird PhD


key highlights
• Award of a grant for $100,000 from the Raine Foundation to Professor Keelan to study ABC transporters and their role in placental development. Graduation of the group’s first two Biomedical Science Honours students in 2008, both with first class Honours degrees. Student prizes awarded to Ambika Singh and Irving Aye for presentations at both local and International meetings. Completion of the group’s first series of projects with several papers submitted for publication
The group has collaborative links with the Department of Anatomy and Human Biology, UWA, the School of Medicine and Pharmacology at Royal Perth Hospital,Telethon Institute of Child Health Research,The Perinatal Research Centre at Melbourne’s Royal Women’s Hospital, and the Liggins Institute at the University of Auckland, NZ.The group is funded by grants from the University of Western Australia, the Ada Bartholomew Trust, the Raine Foundation, the Australian Dental Research Foundation and the NHMRC.Three major grant applications are pending at the time of writing.



L-R: Irving Aye, Jeff Keelan, Ambika Singh and Rebecca Colvin
23
annual report 2009
Fetal Futures Program
Overview
The advent of high resolution ultrasound has provided a safe and effective method to image the fetus prior to birth. Over the past decade in particular, there have been great advances in image quality with the addition of compound imaging, volume imaging and excellence in transducer technology, such that the ability to assess the fetus has reached levels not believed possible 30 years ago.
RESEARCH REPORTS
beyond the intrauterine and neonatal period. In order to provide parents with high quality information about long term effects of conditions diagnosed prior to birth, studies are urgently required to evaluate children with serious disorders recognised prior to birth.The Fetal Futures Program has been developed with the principal aim being to assess the long term outcomes in children who had recognised problems in fetal life.
In addition, the development of ultrafast MRI has provided a superb adjunct to fetal ultrasound imaging, particular for assessment of the fetal brain. Whilst this has been a wonderful journey for parents and health care providers, it has become clear that responsibility for fetal care extends well beyond the intrauterine and neonatal period. In order to provide parents with high quality information about long term effects of conditiIn addition, the development of ultrafast MRI has provided a superb adjunct to fetal ultrasound imaging, particular for assessment of the fetal brain. Whilst this has been a wonderful journey for parents and health care providers, it has become clear that responsibility for fetal care extends well
L-R: Joan Sharpe,Teresa Warner, John Newnham, Jan Dickinson
With financial support from the Channel 7 Telethon Trust and the Women and Infants Research Foundation, researchers have embarked upon a program to locate and evaluate children of various ages who have previously undergone complex treatment before birth.Typically, women receive treatment for their unborn child, give birth (usually at KEMH), and then return to their community with no formal follow-up to ascertain the ongoing consequences of the fetal disease and its treatment. Government databases with computer linkages do not contain the outcomes necessary for such a follow-up program.
Investigators highlights
• Our first project has been to assess the cardiac function of children who received blood transfusions as a fetus to investigate the impact of anaemia and hypoxia upon the developing fetal heart.The cardiac function of children and adolescents who received intrauterine transfusions for severe fetal anaemia secondary to red cell isoimmunisation between 1992 and 2002 at King Edward Memorial Hospital has been assessed. With the successful completion of this initial project, outcome data are being presented at an international scientific meeting in 2010. Our second and current project is the assessment of the long term outcomes of children born with gastroschisis, a congenital defect in the anterior abdominal wall. Medical investigators in Western Australia have had an interest in this condition for several years and the Fetal Futures Program provides us with the opportunity to further develop this research area.This project is currently under way and should be completed by December 2010. Professor Jan Dickinson MD FRANZCOG Winthrop Professor John Newnham MD FRANZCOG Joan Sharpe M Cardiac Ultrasound, AMS Teresa Warner RN RM DMU (Obstetrics & Gynaecology) Dr Madhur Ravikumara MBBS Dr Emma Harris MBBS Dr Luigi D’Orsogna MBBS FRACP Princess Margaret Hospital Dr Corrado Minutillo FRACP Princess Margaret Hospital
Major Sponsors
Channel 7 Telethon Trust Women and Infants Research Foundation

Luigi D’Orsogna
women and infants research foundation
24
Fetal Futures Program
RESEARCH REPORTS
Neurodevelopmental outcomes of infants with gastroschisis in Western Australia: A Retrospective Study
Overview
There is little information on the long-term neurodevelopmental outcomes of infants born with gastroschisis. Gastroschisis is a condition where there is an open defect in the abdominal wall and the baby is born with a large part of the intestinal tract outside the abdominal cavity. There were 90 pregnancies in which a fetus was detected with gastroschisis between January 1997 and December 2007. Eighty-three of these fetuses were born alive and information was collected to determine their outcome.The mean gestational age at birth of these infants was 36 weeks and their mean birth weight was 2.5kgs. All infants had the intestines reduced and the defect closed surgically. Eighty-one of the infants with gastroschisis were born at King Edward Memorial Hospital and all transferred to Princess Margaret Hospital for surgery.The median age of surgical reduction was 4 hours with a range of 1-11 hours. Seventytwo infants underwent surgery under general anaesthesia, the other 11 under sedation and analgesia.The median duration of hospital stay for these infants was 19 days with a range of 9-472 days.There were 3 deaths. Neurodevelopmental data were available on 78% of the survivors and the median IQ at 12 months was 101, with only 1 infant having an IQ less than 80 which is in the intellectually disabled range. One infant had mild cerebral palsy. We conclude that infants with gastroschisis in WA have a high survival rate and incidence of adverse neurodevelopmental outcomes is minimal.
Investigators
Dr Corrado Minutillo FRACP Princess Margaret Hospital Dr Simon Pirie MRCPCH Dr Judith McMichael FRACP Professor Jan Dickinson MD FRANZCOG Dr Shirpad Rao FRACP
Sponsors
Channel 7 Telethon Trust Child Development Unit, WA
25
annual report 2009
Maternity care for rural and remote Aboriginal women in Western Australia:
evaluation of clinical outcomes and cost benefits
Overview
Aboriginal mothers represent around 6.5% of all women who give birth in Western Australia every year and 65% of these women live outside the Perth metropolitan area.Traditional models of antenatal and maternal care in non-metropolitan WA are not meeting the needs of Aboriginal women.This is evident in the considerable disparity between pregnancy outcomes in Aboriginal and nonAboriginal women, with the largest disparity happening in rural and remote locations. Hospital based antenatal services rarely provide the opportunity for women to form a trusting relationship with a midwife. Accessibility is also diminished due to lack of transport and fixed appointment times. Apprehension of being sent to Perth or to a regional centre well in advance of delivery for specialist antenatal care can result in some women avoiding antenatal care altogether, increasing the likelihood of poor outcomes at delivery and costly emergency transfers. Service innovations with a significant involvement of midwives have been introduced in some rural areas of WA to improve care to pregnant Aboriginal women living in the rural and remote parts of the state. Monitoring of pregnancy outcomes before and after the introduction of the service innovations show improved attendance at antenatal services and a greater likelihood of receiving essential antenatal services. However, the numbers of women were too small to
RESEARCH REPORTS
detect differences in maternal or perinatal outcomes, and the lack of evidence of any financial and clinical benefits of the service innovations mean they were not sustained beyond the initial project funding.
Objectives and Benefits
Our study is comparing the health outcomes and cost implications of maternity care provided to Aboriginal women by midwives, general practitioners or community health nurses in the state or private systems. Benefits to be compared include greater antenatal care attendance, earlier first presentation to antenatal care, improved maternal outcomes, improved outcomes for the baby and reduced transfer to tertiary hospitals. Our evaluation method overcomes limitations of small numbers and rare adverse outcomes through the use of modelling techniques to generate hypothetical pregnancy data to sufficiently understand the balance of risks and benefits of models of care under investigation and to inform implementation of these programs in other sites in WA and nationally. This project is consistent with the WA Health reform to address the challenges of increasing maternal health care risk often faced by Aboriginal people.This project is a part of our expanding research activities in the area of health services research at the Women and Infants Research Foundation. We are very grateful to the State Health Advisory Council of The WA Department of Health for funding of this research.
research objectives
• Comparisons of pregnancy outcomes associated with traditional maternity care and the maternity care provided by community-based midwives. Estimation and comparison of costs of maternity care for the traditional and community-based midwifery led model.

women and infants research foundation
26
Investigators
WIRF/School of Women’s and Infants’ Health, UWA Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD Dr Janet Hornbuckle MB ChB MRCOG FRANZCOG Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH Winthrop Professor John Newnham MD FRANZCOG Jeffrey Cannon BSc BBus Student The Combined Universities Centre for Rural Health (CUCRH) Melissa Barrett RN RM MSc (Nursing) Professor Ann Larson BA MA PhD Professor Isabelle Ellis RN RM MPHTM PhD Glenda Taylor EN Geraldton Regional Aboriginal Medical Service (GRAMS) Rhonda Bradley RN RM Cindy Porter BSc (Hons) MSc (Diabetes Education) PhD Candidate Dr Charlie Greenfield MBBS PhD FACP Department of Health Western Australia Gerard Montague BEc Grad Dip Bus Fin
Major Sponsor
State Health Research Advisory Council, WA Department of Health
Dorota Doherty
Janet Hornbuckle
Jeffrey Cannon
John Newnham
Karen Simmer
Glenda Taylor
Ann Larson
Melissa Barrett
27
annual report 2009
Anaesthesia, Pain Relief and Outcomes after Surgery
Overview
The Department of Anaesthesia and Pain Medicine is a small, highly productive research unit with a focus on applied clinical research that translates to practice change for improved patient management. Special interests are in the application of spinal and epidural techniques and drugs; novel technologies and approaches for pain relieving drugs; and the effects of such drugs during breast feeding.
RESEARCH REPORTS
sampling cerebrospinal fluid at the time of anaesthesia for caesarean section. Do acupressure wrist bands prevent nausea during labour? A randomised trial is comparing active and sham acupressure at the wrist to determine whether sickness, a common problem during labour, can be reduced without drug therapy.
Does epidural pethidine given for pain relief after Caesarean section show significant transfer into breast L-R: Neil Muchatuta, Desiree Cavill, milk, and either affect milk production Work this year has included research Tracy Bingham, Michael Paech or interfere with breast-feeding? This on questions such as: study in collaboration with Human Are neuroprostanes (inflammatory compounds that may Lactation and Breast-feeding researchers will assess the increase when the brain is injured or affected by disease) composition of breast milk, the sucking behaviour of the infant detectable in normal pregnant women or those with preand the concentrations of drug in the mother and baby. eclampsia? In this study we measure neuroprostane levels by
Chief Investigators research highlights
• Publication of the results of studies on the transfer of the pain relieving drug tramadol into breast milk; on a new approach to oral pain relief after Caesarean section; and on the risk of various complications associated with general anaesthesia for caesarean section, including being “aware” during surgery. Organisation or commencement of new clinical trials on a new formulation of the pain relieving drug fentanyl (a wafer under the tongue); on new equipment for pain relief (needles and pumps); on ultrasound imaging to assist with epidural insertion in obese patients; and on the optimum drug doses to treat falls in blood pressure after anaesthesia for Caesarean section. New grants from the Australian Society of Anaesthetists, the Women and Infants Research Foundation,The Western Australian Institute for Medical Research and the health industry. Winthrop Professor Michael Paech FANZCA DM Clinical Senior Lecturer Dr Nolan McDonnell FANZCA Associate Professor Stephen Lim MPharm Emeritus Professor Ken Ilett PhD Dr Neil Muchatuta FRCA Dr Aneeta Sinha FRCA Dr Yasir Al-tamimi FRCA

Researchers/Investigators
Desiree Cavill RM Tracy Bingham RM Dr Timothy Pavy FANZCA Dr Roger Browning FANZCA Dr Lloyd Green FANZCA Dr Chris Mitchell FANZCA Dr Justin Holborrow FANZCA

Major Sponsors
The Australian Society of Anaesthetists Women and Infants Research Foundation
women and infants research foundation
28
Neonatal Nutrition:
PANTS: Probiotics And NeonaTes Study
Overview
Probiotics are the live beneficial microorganisms that are naturally present in the digestive tract.These friendly bacteria promote health by suppressing the growth of potentially harmful bacteria, improving immune function, enhancing the protective barrier of the digestive tract, and helping to produce vitamin K. Human beings have been consuming these beneficial bacteria for hundreds of years in the form of various food supplements, the commonest being yogurt, and commercial products such as “Yakult”. Death and diseases like necrotising enterocolitis (NEC- a condition with a gangrenous bowel), infections, and feeding difficulties due to immature bowel function are a major problem in premature babies worldwide. Many clinical trials have evaluated the safety and benefits of probiotic supplementation in premature babies. Dr Patole’s group of researchers from KEMH has reported a meta-analysis of these trials in the medical journal,The Lancet. This analysis showed that the risk of death and NEC was reduced by 53% and 64%, respectively, in babies receiving probiotic supplement compared with control group babies.The time to achieve full milk feeds was also significantly less (by an average of nearly three days) in babies receiving a probiotic supplement.These results indicate the tremendous potential of probiotic supplementation in saving premature babies from death and disease.
RESEARCH REPORTS
Friendly bacteria to save premature babies from death and disease
Objectives
PANTS (Probiotics And NeonaTes Study) is a two step research project sponsored by a Telethon Grant. It involves rigorous evaluation of the safety and efficacy of a locally available probiotic product before selecting it for routine use in premature babies. Step one involves laboratory testing of the product to confirm its contents (taxonomy confirmation) and safety (e.g. contaminants, unspecified components, osmotic load, pH). Step two is a pilot clinical trial to evaluate the efficacy (ability of the probiotic bacteria in the product to colonise the gut), and safety (tolerance, and risk of infection due to the probiotic organisms) in premature babies. Taxonomic testing of the product is vital as supplements such as probiotics are not as strictly regulated as medicines. The published literature suggests that to be effective in neonates, more than one variety of bacteria, and at least 1 billion total bacteria are required per day. The Investigators are currently sourcing alternative products with a suitable bacteria mixture and adequate number to continue with part two of the study.
Investigators
Associate Professor Sanjay Patole DrPH FRACP Dr Tony Keil MBBS FRCPA Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH Associate Professor Patricia Conway PhD
main image courtesy of Sunday Times
Major Sponsors
Channel 7 Telethon Trust
Sanjay Patole
Dorota Doherty
Karen Simmer
29
annual report 2009
Neonatal Nutrition:
The PeaNut Trial
Overview
Human milk is the best and recommended source of nutrition for infants but its composition is variable from mother to mother and from day to day. Human milk requires the addition of commercial fortifiers to meet the very high protein and energy needs of preterm infants. Current practice is to assume a standard milk composition and to add the same amount of fortifier to all preterm infants’ feeds, with the aim of promoting growth and accretion of nutrients at intrauterine rates. Our previous study, using an instrument called The PEAPOD™ to measure the effect of macronutrient intake on body composition, supported the evidence that accurate protein intake is important for the accretion of lean tissue. Results revealed that at term corrected age, preterm infants are fatter and lighter than infants born at term. The significance of this early growth pattern is unclear but concerning, since altered nutrition during critical windows of developmental can potentially have long term metabolic consequences such as increasing the risk of diabetes and heart disease.
RESEARCH REPORTS
Objectives
We are conducting a randomised clinical trial to determine if growth targets can be better achieved by individualising the fortification of human milk based on the individual needs of preterm infants. We are using mid-infrared technology (MIRIS) to measure the composition of the milk feeds. Babies in the intervention group are receiving individualised supplementations with commercial fortifier, carbohydrate and fat depending on base levels in mother’s milk. The control group is receiving milk feeds fortified according to standard practice which is routine amounts of commercial fortification added to all milk feeds. Air displacement plethysmography technology, ultrasound and routine anthropometric measures are being used to assess growth and percentages of lean tissue and fat. The trial is due for completion in October 2009. We hypothesise that individualised nutrition will result in better growth with lower amounts of body fat.
Investigators
Gemma McLeod MSc APD Associate Professor Jill Sherriff PhD Winthrop Professor Peter E Hartmann PhD Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH Liz Nathan BSc, Biostatistician Dr Donna Geddes PhD
Major Sponsors
Australian Rotary Health Rotary Club of Thornlie The University of Western Australia Stan Perron Charitable Trust
Donna Geddes
Liz Nathan
Gemma McLeod
Peter Hartmann
women and infants research foundation
30
Neonatal Nutrition:
RESEARCH REPORTS
Intravenous Nutrition – fish oil and olive oil for very preterm infants - Efficacy and safety of a new fish oil based lipid emulsion (SMOFlipid) compared with olive oil based lipid emulsion (Clinoleic) in pre term (<30 weeks) neonates – a randomised controlled trial.
Overview
Fat emulsions are an essential part of intravenous or parenteral nutrition, combining a high energy load with an essential fatty acid intake. Fat emulsions used in Australia for parenteral nutrition in preterm neonates have been based on either soybean oil or olive oil. Fat emulsions are an essential part of intravenous or parenteral nutrition, combining a high energy load with an essential fatty acid intake. Fat emulsions used in Australia for parenteral nutrition in preterm neonates have been based on either soybean oil or olive oil. We currently use an olive-oil based fat (Clinoleic) at KEMH which has a high ratio of omega-6 to omega-3 fatty acids (9:1) and this may not be ideal for supply of omega-3 fatty acids, which are important for neuro-development and vision of preterm neonates. A newly available fish-oil-based fat (SMOF lipid) has a more appropriate ratio omega-6 to omega-3 fatty acids (2.5:1). SMOF lipid also contains olive oil (25%), coconut oil (30%) and soybean oil (30%). Better lipid clearance, reducing the risk of liver toxicity, reduced oxidative stress, lower immune-activity and antiinflammatory effects are other potential advantages of SMOF.
Objectives
Our previous NHMRC clinical trial has shown that high dose oral fish oil supplements increase omega-3 fatty acid levels and reduce disability in preterm infants.This trial will assess fatty acid intake in the most vulnerable period of preterm life, which is in the weeks before babies are mature and stable enough to tolerate milk feeds and depend on intravenous nutrition. Very preterm infants will be randomised to fish-oil or olive-oil intravenous lipid prepations and their health and nutritional outcomes assessed. We hypothesise that SMOF emulsion will lead to increased omega- fatty acid levels in red blood cells and plasma, and reduce oxidative stress in high-risk preterm neonates dependent on parenteral nutrition support.
Investigators
Dr Girish Deshpande FRACP Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH Associate Professor Trevor Mori PhD Professor Kevin Croft PhD Judith Kristensen BPharm
Major Sponsors
Women and Infants Research Foundation
31
annual report 2009
Impact of Caffeine and Maturation on Respiratory Control in Preterm Infants
Overview of Progress
Infants born preterm frequently experience immature or abnormal respiratory patterns characterised by exaggerated pauses between breaths, alterations in heart rate and blood oxygen levels. Caffeine improves respiratory patterns in preterm infants and is frequently given to infants in the special care nursery to stimulate breathing and to reduce the need for ventilatory support.This study aims to investigate how breathing patterns reflecting respiratory control in preterm infants, and the impact that caffeine has upon this process. Our research nurse (Ann McDonald) has industriously recruited infants to the study over the course of the year. Currently, respiratory pattern measurements from almost 30 infants have been acquired using specialised lung function equipment that measures airflow at the mouth during normal breathing.This technique for measuring respiratory function has generally been applied only to term and preterm infants who
RESEARCH REPORTS
are relatively mature. In this study we are attempting to obtain measurements from preterm infants who are relatively immature, at a corrected gestational age of 36 weeks. In addition to the data currently available, we plan to obtain respiratory tracings from a further 15 infants over coming months. We are in the process of analysing patterns of respiratory variability obtained during normal quiet sleep using mathematical techniques specifically designed to identify properties of organization and feedback memory within complex signals. Quantifying these processes provides an opportunity to improve our understanding of the respiratory control system in small infants. We hope that a comparison of data signals obtained from infants either treated or not treated with caffeine will provide improved insight to the impact of this medication on respiratory control maturation in sick and preterm infants.
study objectives
• This study aims to examine how the respiratory control system undergoes maturation in the preterm infant and how this process may be influenced by the administration of caffeine.
Study Investigators
Dr David Baldwin FRACP PhD Dr Sven Schulzke MD Ann McDonald RN Professor Jane Pillow FRACP BMedSc PhD Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH
Major Sponsors
Channel 7 Telethon Trust
David Baldwin
Sven Schulzke
Jane Pillow
Karen Simmer
women and infants research foundation
32
Mental Health during pregnancy and the post natal period
Overview
This research focussed on whether or not antidepressant medication used during pregnancy would have any impact on newborns. Antidepressants cross the placenta in significant quantities. A small percentage of babies show minor changes for a few days soon after birth. Active intervention is not usually needed for these changes and only supportive treatment is usually required.
RESEARCH REPORTS
new born babies for routine screening.This showed that, in the main, the levels in the baby had dropped significantly from delivery to day three.The rate of reduction varies between the different antidepressants. Babies were examined on the first three days by midwives by using the Neonatal Abstinence Scale. They were also tested using a scale that tests the effect of circulating antidepressants (the neonatal Serotonin score). On day three, all of the babies were examined using an extremely detailed assessment tool that has been validated internationally (the Brazelton Neonatal Behavioural Assessment Scale – BNBAS).The range of assessments done on the babies in the post natal period confirmed that a small number of the babies of mothers who took antidepressants during pregnancy had a range of self limiting symptoms. This research is important in terms of informing pregnant patients who are considering antidepressant medication during pregnancy. In addition, we now recommend to mothers who need to take antidepressant medication during pregnancy that they consider reducing the dose of their antidepressant medication in the days or weeks prior to delivery if it is clinically reasonable.This will almost certainly reduce the incidence of unsettled behaviour in babies in the post natal period.
Key Highlights
Patients on the newer antidepressants were enrolled into the study during pregnancy. A number of women who were not on antidepressants agreed to enrol in the study to act as control subjects. Blood was taken from mothers in labour and from the placenta soon after delivery. Comparison of the levels of antidepressant in the mother’s blood and the placenta allowed an accurate measurement of the degree of transfer of antidepressant across the placenta to the fetus. Our study showed that, on average, levels in the fetus were 70-85% of the levels in the mother. Independent research has shown there is no long term consequence from this exposure to antidepressants during pregnancy. Blood was also taken from the newborn baby on day three – at the same time that blood is taken from
Investigators/Authors
Dr Jonathan Rampono MBChB MFGP FRANZCP Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH Emeritus Professor Kenneth Illet BPharm PhD L Peter Hackett LRCS AAIMLS Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD Robin Elliot RN Chooi Heen (Yen) Kok RN Arlette Coenen BSc Tiffany Foreman RN RM CNC
Funding
Women and Infants Research Foundation
33
annual report 2009
Australian Ovarian Cancer Study (AOCS)
Overview
Since July 2008, the Western Australian Gynaecologic Cancer Service has worked in collaboration with the Women and Infant Research Foundation on two important projects. It has been our pleasure to have two exceptional research nurses, Colleen Ball and Cherry Young working on these projects. AOCS commenced in 2001 with the hypothesis “that different subtypes of ovarian cancer, at the histological and genetic level, are etiologically distinct and will be associated with different epidemiologic risk factors, with an emphasis on potentially modifiable factors. Similarly, we propose that low-risk genes in key pathways may influence susceptibility to ovarian cancer and may modify the effects of known risk factors.” The study was to create a uniquely powerful resource for ovarian cancer research comprised of bio-specimens, clinical and epidemiological data. Funding was initially provided by the
RESEARCH REPORTS
United States Department of Defence for the collection of extensive epidemiological data and collection of blood for genetic analyses and frozen tumour specimens for molecular studies. Current funding is from an NHMRC grant. Although recruitment ceased in 2006 when recruitment of the target cohort was greatly exceeded (as collaborators Western Australia recruited 284 cases), there is ongoing prospective collection of clinical follow-up information. Our research nurses have ensured high quality data are being collected. Less than 2% of the study population has been lost to follow-up. Numerous publications have already resulted from this study. Details of this important study are available on the following website: http://www.aocstudy.org/index.asp
L-R: Cherry Young, Colleen Ball
Principal Investigators
Professor David Bowtell – Peter MacCallum Cancer Centre Professor Adele Green – Queensland Institute of Medical Research Dr Anna DeFazio – Westmead Hospital
Western Australian Clinical Collaborators
Clinical Professor Tony McCartney Dr Yee Leung, Head of Department, Western Australian Gynaecologic Cancer Service Clinical Professor Ian Hammond
Research Nurses
Colleen Ball RN RM BN Cherry Young RN RM
Yee Leung
women and infants research foundation
34
RESEARCH REPORTS Laparoscopic Approach to Carcinoma of the Endometrium: An International Multicentre Randomised Phase 3 Clinical Trial (LACE) Overview
The primary hypothesis is that Total Laparoscopic Hysterectomy (TLH) is associated with equivalent diseasefree survival when compared to the standard treatment of Total Abdominal Hysterectomy (TAH) for women with apparent Stage I endometrial cancer. The primary objective is to assess disease-free survival at 4.5 years postoperatively for women with apparent Stage 1 endometrial cancer, comparing patients who are randomised to receive Total Laparoscopic Hysterectomy (TLH) and patients who are randomised to receive Total Abdominal Hysterectomy (TAH). Recruitment commenced in October 2005.The trail aims to recruit 755 women; as of August 2009 a total of 621 women were recruited, of whom 74 were recruited from WA. Details of this study are available on the following website: http://www.gyncan.org/trials/current-trials/view/lace-clinical-trial/1
Principal Investigator
Professor Andreas Obermair, Queensland Centre for Gynaecological Cancer
Western Australian Chief Investigator
Dr Yee Leung, Head of Department, Western Australian Gynaecologic Cancer Service
Western Australian Associate Investigators
Clinical Professor Tony McCartney Clinical Professor Ian Hammond Dr Stuart Salfinger
Research Nurses
Colleen Ball RN RM BN Cherry Young RN RM
Yee Leung
Colleen Ball
Cherry Young
35
annual report 2009
Neonatal Respiratory Medicine and Physiology
Overview of Research
The neonatal respiratory research group aims to understand the growth and development of the lung and the systems controlling breathing after preterm birth.We also aim to learn more about the factors that cause lung injury in the neonatal period and to investigate new methods of mechanical ventilation with the purpose of minimising lung injury and finding ways to optimise the long term respiratory health and well-being of premature babies. In 2008-9, physiological studies are undertaken in the neonatal intensive care unit at KEMH, and within the research facilities at University of Western Australia. Specific areas of investigation
RESEARCH REPORTS
include measuring the physiological deadspace in ventilated preterm infants which will help us know how much air to give with each ventilator breath for babies of different sizes and levels of maturity. Other studies have investigated the potential application of high-frequency jet ventilation, which delivers miniature “angel” breaths to the babies lungs. These studies have specifically focused on working out what are the best ways to use this ventilator to avoid lung injury in premature babies. In other studies we have also investigated whether changing body temperature, using heliox instead of medical air, and also whether incorporating variability into the breathing pattern can reduce the injury to the lung which so often complicates mechanical ventilation.
Chief Investigators
Professor Jane Pillow FRACP PhD Dr Sven Schulzke MD Dr Graeme Polglase BSc (Hons) PhD Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH
research highlights
• Achieved 80 % target enrolment group for the evaluation of physiological dead space in ventilated preterm infants (completion date Oct 2009) New Investigator Award presented to Dr Gabby Musk for her studies on high-frequency jet ventilation in the setting of acute respiratory distress in the preterm lung.
Researchers
Dr Gabby Musk BSc BVMS Cert VA Dipl ECVAA MRCVS PhD Candidate Dr Rolland Neumann Neonatal Senior Registrar Anne McDonald RN Carryn McLean BSc (Hons) Research Assistant Richard Dalton BSc Research Assistant Andrea Lee BSc (Hons) PhD Candidate

Major Sponsors
Women and Infants Research Foundation Raine Foundation, UWA Fisher & Paykel Healthcare National Health and Medical Research Council of Australia National Institutes for Health (USA)
Jane Pillow
Sven Schulzke
Graeme Polglase
Karen Simmer
Gabby Musk
37
annual report 2009
Breastfeeding research
Overview of Research
The aims of the Human Lactation Research Group led by Professor Peter Hartmann are to provide the Foundation, through basic research, for the development of evidencebased lactation practices.The value of this work has been internationally acknowledged with the presentation of the highly regarded Rank prize for outstanding research into infant nutrition to Professor Peter Hartmann.
RESEARCH REPORTS
from the breast that was previously pierced.This is important information for women and clinicians, as nipple piercing is generally not regarded as detrimental to lactation.Their letter was published in the highly esteemed Journal for the American Medical Association. Recently a commercial Human Milk Analyser became available to replace time-consuming laboratory tests.This tool has undergone extensive validation by Dr Ylenia Casadio.The results of her work have confirmed that the equipment is sensitive enough to be used clinically.Thus the analyser has been integrated into research studying the nutrition of preterm infants at King Edward Memorial Hospital.
In October 2008 the group was provided a very sophisticated piece of equipment by their main sponsor Medela AG that is essential to many of the clinically orientated studies being performed. In fact it attracted much media attention.The PhD student Elizabeth Thomas has LactaSearch is unique in that it can won a prize for her groundbreaking obtain simultaneously many types of work in the field of molecular biology. data that are collected by sensors Mammosphere grown from stem cells We have recently been able to placed on the breastfeeding infant. from human milk harvest stem cells from breastmilk This allows the suck-swallow-breathe that give rise to secretory (milkreflex to be more fully investigated. It producing) breast tissue. Elizabeth has achieved the extremely also operates two computerised pumps.These pumps are so technically difficult task of successfully culturing these cells into flexible they allow the pattern of a babies sucking to be mammospheres enabling further experimental analysis. As a recorded and then applied to the breast pump.This exciting result she has won a national prize for Excellence in Medical new technology has already been integrated into three of the Research from the Australian Society for Medical Research and major studies. a travel award to present her work at the 6th International This year our medical researchers have assisted in a clinical case Symposium on Milk Genomics and Human Health in Paris. study series of women who experienced low milk production
research highlights
• • • • Million dollar equipment secured to facilitate future lactation research Discovery of an association between nipple piercing and decreased milk production for some women New Human Milk analyser validated for clinical use Mammospheres grown from cells from human milk by prize-winning PhD student Elizabeth Thomas
women and infants research foundation
38
Lactasearch - new advanced technology to assess breastfeeding infants and breast pumping
Chief Investigator
Winthrop Professor Peter Hartmann BRurSc (Hons) PhD
Research Students
Danielle Prime BSc (Hon) Gemma McLeod MSc APD Ibrahim Abdul MSc Sadaf Khan BSc Vanessa Sakalidis BSc (Hon) Claire Moliniari BSc (Hon) Elizabeth Thomas BSc Kristin Piper BSc Sharon Perella MSc Ruth Abbott
Associate Investigators
Dr Donna Geddes PhD Dr Naomi Trengove PhD Dr Jacqueline Kent PhD Dr Ching Tat Lai PhD Dr Ylenia Casadio PhD Dr Lynda Chadwick MBBS FRAP (Paed) Dr Jane Deacon MBBS Dr Marnie Rowan MBBS Catherine Garbin IBCLC Lukas Christen HF (Med Eng; Switzerland)
Major Sponsors
Women and Infants Research Foundation Medela AG
Peter Hartmann
Donna Geddes
Naomi Trengove
Jacqueline Kent
Ching Tat Lai
39
annual report 2009
The fetal and childhood origins of Polycystic Ovary Syndrome (PCOS)
Overview of Research
The Polycystic Ovary Syndrome (PCOS) affects up to 10% of women of reproductive age, which translates to around 350,000 women in Australia. It is the most common hormonal disorder in women.The syndrome has far-reaching adverse implications for general and reproductive health, including menstrual disorder, obesity, infertility, miscarriage, pregnancy complications, increased risk of diabetes and possibly heart disease. PCOS commonly causes cosmetic problems such as excess body hair and acne. The underlying causes of PCOS are not known but are thought to arise during intrauterine (fetal) life and to be modified by aspects of childhood health, particularly overweight and obesity. Using a large and unique cohort of adolescents aged 14-16 from the Raine Study we are investigating the intrauterine and early childhood causes of PCOS. • •
RESEARCH REPORTS
The study is completed with 250 girls having undergone timed ultrasound scans of their ovaries and blood plasma hormonal assessment. Approximately 15% have been diagnosed with PCOS. In a subset of 349 girls we have demonstrated for the first time that both birth weight and weight gain in childhood predict age at menarche. • Lower birth weight ratio combined with higher body mass index (BMI) at 8 years of age predicted earlier age at menarche and this relationship existed across normal birth weight and BMI ranges. • Six presentations at the annual meeting of Society for Gynaecological Investigation (SGI) in Glasgow, March 2009
• This year we have had one research paper accepted for publication, two more are under review by the journals and six more are in preparation. • We have shown that development of PCOS in adolescent girls was not associated with increased androgen concentrations in their mothers during pregnancy.
Research Outcomes and Highlights
• First research group to study the intrauterine and early childhood precursors of PCOS.
Investigators
Winthrop Professor Martha Hickey BA (Hons) MSc MBChB MRCOG MD FRANZCOG Professor Roger Hart MRCOG FRANZCOG CREI Dr Deb Sloboda BSc (Hons) MSc PhD Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD Dr Helen Atkinson BSc (Hons) PhD Professor Steve Franks FRCP PhD RS
Research Staff
Lee Ann Mahoney RN RM, Project Manager Sarah Simpson RN Helen Box RN RM Cherry Young RN RM
Martha Hickey
Roger Hart
Deb Sloboda
Major Sponsors
National Health and Medical Research Council The University of Western Australia Department of Health of Western Australia We thank the Raine Study girls, their families and the staff for making this project a success.
Dorota Doherty
Helen Atkinson
Lee Ann Mahoney
Sarah Simpson
Helen Box
Cherry Young
women and infants research foundation
40
Vaginal Oestrogen Study
RESEARCH REPORTS
Efficacy and systemic absorption of vaginal estradiol and estriol in postmenopausal breast cancer patients with symptomatic vaginal dryness using the aromatase inhibitor, anastrozole.
Overview of Research
Low estrogen levels in postmenopausal women are commonly associated with symptoms of vaginal dryness, soreness, pain with intercourse, itching and urinary frequency. Anastrazole is an Aromatase Inhibitor (AI), used in the treatment of estrogen and progesterone receptor positive breast cancer.This treatment acts by reducing the circulating levels of oestrogens. With the increasing use of AI the number of postmenopausal breast cancer patients affected by vaginal dryness is likely to increase. Vaginal oestrogens are used to treat the symptoms of atrophic vaginitis described and whilst they primarily act locally they are also absorbed into the systemic circulation in small but measurable amounts.
Research Aims
To objectively measure vaginal atrophy in symptomatic breast cancer patients taking AI and to compare the efficacy, local vaginal effects and systemic absorption of two different vaginal treatments and a non-hormonal lubricant in women taking arimidex in order to find which treatment is most effective.
Chief Investigators
Winthrop Professor Martha Hickey BA (Hons) MSc MBChB MRCOG MD FRANZCOG Winthrop Professor Christobel Saunders MBBS FRCS FRACS Professor of Surgical Oncology
Research Staff
Dr Manju Ambekar MBBS MD MRCOG FRANZCOG Dr Lesley Ramage MBChB Dr Helen Atkinson BSc (Hons) PhD Lee Ann Mahoney RN RM, Project Manager Sarah Simpson RN
Major Sponsors
AstraZeneca Pty Ltd
Martha Hickey
Manju Ambekar
Helen Atkinson
Lee Ann Mahoney
Sarah Simpson
Lesley Ramage
41
annual report 2009
Mechanisms of irregular bleeding with Implanon contraceptive implants
Overview of Research
Abnormal uterine bleeding (AUB) limits the use of long-term progestin-only contraceptives (LTPOCs): LTPOCs are safe, effective, and recommended when estrogencontaining contraceptives are contraindicated by hypertension, coronary and cerebral vascular disease, venous thrombotic disorders, lactation, hepatic adenomas, cholelithiasis, breast and endometrial carcinoma and other estrogen-responsive pathologies. The most popular LTPOC is Implanon a subdermal implantable contraceptive. Implanon is a single rod containing etonogestrel, a 3rd generation progestin that is effective for three years. Approximately, 600,000 women now use Implanon world-wide with the numbers rapidly increasing. Australia has had one of
RESEARCH REPORTS
the most enthusiastic uptakes of Implanon of any country in the world. Implanon has gained wide spread popularity because it provides prolonged, highly effective contraception which greatly improves compliance and contraceptive efficacy. Like all LTPOCs, Implanon is highly effective with very low pregnancy rates but its use is limited by irregular and prolonged AUB.The association between the high rate of discontinuation of LTPOC use and AUB reflects the perception that a normal menstrual pattern is an indicator of both reproductive health and the absence of pregnancy.
Preliminary Data
This project is ongoing.To date 16 women have been enrolled.
Chief Investigators research aims
• • • To understanding the mechanism of irregular bleeding with long-acting progestin only contraceptives. To establish whether Implanon, the only available implantable system, impairs endometrial blood flow. To develop new treatment approaches for irregular bleeding. Winthrop Professor Martha Hickey BA (Hons) MSc MBChB MRCOG MD FRANZCOG Professor Charles Lockwood MD PhD, Chair of OBGYN,Yale University CT
Research Staff
Dr Carmel Sheridan MB BCh BAO MRCOG MRCPI Dr Manju Ambekar MBBS MD MRCOG FRANZCOG Dr Helen Atkinson BSc (Hons) PhD Lee Ann Mahoney RN RM, Project Manager Sarah Simpson RN
Major Sponsors
National Institute of Health (USA) Department of Health of Western Australia
Martha Hickey
Manju Ambekar
Helen Atkinson
Lee Ann Mahoney
Sarah Simpson
women and infants research foundation
42
Menopause Symptoms After Cancer (MSAC)
Overview of Research
• A study comparing the absorption of vagifem or ovestin and a non hormonal treatment for women taking aromatase inhibitor Anastrozole (Arimidex) for women experiencing symptoms of atrophic vaginitis. • Comparison of the nature, severity and duration of menopausal symptoms following cancer compared to spontaneous menopause. • Comparison of endocrine related quality of life in chemotherapy induced ovarian failure compared to spontaneous menopause King Edward Memorial Hospital established the first multidisciplinary menopause clinic dedicated to women with a history of cancer in 2003 (MSAC: ‘menopausal symptoms after cancer’). This unique clinic services the entire state of Western Australia and also generates novel research. Referrals are invited from metropolitan and rural GPs, breast surgeons, oncologists, clinical geneticists and specialist breast nurses. During this period (January 2003 - December 2008), these 720 women received a total of 1,715 clinic visits, with 42% requiring only one visit.
RESEARCH REPORTS
The KEMH based team provides individualised evidence-based multidisciplinary management.Team includes gynaecologists, general practitioners with comprehensive knowledge of menopause, dietician, research staff, nursing staff and a Clinical Nurse Specialist-MSAC, with expertise in breast cancer, menopause and with a special interest in cancer and sexuality. Menopausal symptoms are common following treatment for cancer, particularly breast and gynaecological cancers.The most frequent and severe menopausal symptoms reported by women included hot flushes, sweating at night, loss of interest in sex, difficulty sleeping and fatigue. Survival from cancer is generally improving and the number of women experiencing menopausal symptoms will most likely increase. In addition this model of care incorporates educational and research opportunities. Monthly multidisciplinary meetings are held to discuss all new and complex management of women who attend the clinic and a venue to provide an educational component.
Chief Investigators
Winthrop Professor Martha Hickey BA (Hons) MSc MB ChB MRCOG FRANZCOG MD Winthrop Professor Christobel Saunders MBBS FRACS FRCS Professor of Surgical Oncology
Research/Investigators
Jane Gregson Bch Nsg RN Helena Green Bch Nsg RN Chris Laird RN RM Anne Breadcell
Major Sponsors
National Breast Cancer Foundation Department of Health of Western Australia National Health and Medical Research Council, Australia The University of Western Australia
43
annual report 2009
Substance Use in Pregnancy
Transmission of buprenorphine in breastmilk
Overview
Buprenorphine in the form of Temgesic® has been used around the world (including Australia) since the 1980s as a pain-relieving drug. In this form it is not used for the treatment of opioid dependence.The use of buprenorphine for treating opioid dependence officially commenced in the 1980s. Since then the drug has been approved for the treatment of opioid dependency in several countries around the world, including France, which became the first country to use it as a substitution therapy in 1996. Buprenorphine offers advantages over methadone in terms of safety, the relative ease of withdrawal, the need for less frequent administration, ease of transition into other treatments and flexibility of treatment. Buprenorphine, marketed as Subutex® or Suboxone®, is a pregnancy category C drug and in Australia is not recommended for use in pregnancy or breastfeeding. However, a growing number of women are choosing to use the drug (either prescribed or obtained illegally). Buprenorphine appears to be a viable alternative to methadone for treatment of pregnant opioid dependent women, though further research is needed to confirm this.The Pilot Study of the WA Register of Buprenorphine Use in Pregnancy and Lactation has been completed with data on 13 mother infant dyads. One of the objectives of this study was to make recommendations on the
RESEARCH REPORTS
potential role of buprenorphine as a treatment option in the management of opioid dependent women during pregnancy and breastfeeding.The findings indicate that, in comparison to methadone, buprenorphine is safe to use during pregnancy. However, we have no data on concentrations of the drug in breastmilk and are unable to provide evidence based information to opioid-dependent mothers on buprenorphine to guide decisions on whether or not to breastfeed their infants.
Objectives
We have been funded by the Foundation to conduct a study on the transmission of buprenorphine in breastmilk of lactating mothers.The sample will consist of breastfeeding, buprenorphine mothers at least two weeks post partum.The urine and milk samples will be provided by the mothers, at home, and collected by the research midwife. At this visit the midwife will assess the infants’ well being and make any referrals deemed necessary The hypotheses to be tested are (a) that quantifying the concentration of buprenorphine in breast milk of lactating mothers will yield sufficient information to enable appropriate advice to be provided to women and (b) that sublingual buprenorphine will not significantly decrease milk production at the usual doses used for opiate substitution.
research highlights
• • Recruitment commenced in March 2009. Preliminary data from the first two patients in the study are available and suggests that buprenorphine exposure of infants via breastmilk is low and unlikely to cause adverse effects.
Investigators
Professor Anne Bartu PhD FRCNA Dr Dale Hamilton FRANZCOG Emeritus Professor Ken Ilett BPharm PhD Associate Professor (Adj) Dorota Doherty PhD S O’Halloran Msc Renate McLaurin RN RM BHlth Sc
Anne Bartu
Dale Hamilton
Dorota Doherty
Renate McLaurin
women and infants research foundation
44
Family vascular risk factors in the prediction of pre-eclampsia
Overview of Research
Pre-eclampsia is a serious complication of pregnancy, causing increased perinatal and maternal morbidity and mortality. It afflicts 5-6% of pregnancies in WA and is responsible for approximately 15-20% of preterm births.The incidence of the condition is higher in first time pregnancies (approximately 10%). As there is no prior pregnancy history in nulliparous women to inform the risks of developing pre-eclampsia, we believe it is important that this group be looked at in detail. Pre-eclampsia is characterised by hypertension, endothelial damage, activation of inflammatory pathways and activation of coagulation pathways.These disturbances are associated with impaired placental perfusion and often poor fetal growth with an increased risk of stillbirth, abruption of the placenta and maternal complications related to severe hypertension and widespread vascular damage. The cause of pre-eclampsia is unknown. It is likely that there is no single cause and that the disorder may result from a variety of predisposing states. Major contributors to increased risk are hypertension, renal disease, autoimmune disorders, thrombophilias and multiple pregnancy.
RESEARCH REPORTS
Research Objectives
This study will interrogate the hypothesis that the risk of preeclampsia and associated pregnancy complications relate to family history of cardiovascular disease in the pregnant woman and her partner. During routine antenatal appointments we asked over 1000 first-time mothers and their partners a series of questions about their family health history. After delivery we are collecting pregnancy and birth outcomes. A database will be used to assess any relationships found. We will test if the medical history of the father of the baby may additionally inform the prediction of the incidence of pre-eclampsia in the mother. Our collaborations with groups of international researchers are continuing with advances being made towards better prediction of the progression of pre-eclampsia during individual pregnancies.
Investigators
Clinical Associate Professor Barry Walters FRACP Claire Parker BSc (Masters by Research candidate) Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD Dr Natalie Oud MBBS
Major Sponsors
Pfizer Australia
L-R: Dorota Doherty, Claire Parker, Natalie Oud, Barry Walters
women and infants research foundation
46
Evaluation of Preliminary Forensic Specimen Kits in recent sexual assault
Overview
The Sexual Assault Resource Centre (SARC) was established in Perth in 1976, more than 30 years ago. It provides a 24 hour comprehensive and co-ordinated medical, forensic and counselling service to both males and females aged 13 years and over, who allege recent sexual assault. Approximately 360 emergency cases are seen each calendar year.
RESEARCH REPORTS
complete examination then the use of the Preliminary Forensic Specimen Kits also allows the person to eat, drink and pass urine following the kit being used, without the possibility of losing forensic evidence.This improves the care and comfort of the person who has been recently sexually assaulted without compromising potential forensic evidence.
Research Objectives
This project aims to assess the Following a recent sexual assault it is L-R: Debbie Smith, Maureen Phillips, usefulness of the Preliminary Forensic vital that a person has adequate Rae Cummins Specimen Kits in terms of rates of access to not only medical care but recovery of a reportable DNA also forensic care, if they so wish. profile. In order to determine the usefulness of the kits the Forensic evidence deteriorates rapidly with time and with DNA profile yield of the Preliminary Forensic Specimen Kits activities such as eating, drinking, showering and passing urine. If will be compared to that of the forensic specimens from the forensic evidence cannot be collected early it may be lost subsequent complete forensic examination. completely. However, an immediate forensic examination is not always possible due to a lack of forensically trained medical The Sex Assault Squad of the WA Police has received staff, particularly in rural areas or due to concomitant medical consistent and specific SARC training on the use of the and psychosocial requirements, which take priority over the Preliminary Forensic Specimen Kits and have now taken over forensic examination. the responsibility of training police officers about the use of the SARC has developed Preliminary Forensic Specimen Kits for use by doctors and nurses and by WA police in both the metropolitan and rural areas. In cases where there is a delay before a complete forensic examination can be carried out, the kits can be used to collect early forensic evidence specimens so that potentially important forensic evidence is not lost.The kits allow doctors, nurses and police officers to guide a person through the self-collection of early oral, vulval, peri-anal and urine specimens if indicated, prior to a full medical and forensic examination. If there is a considerable delay prior to the kits in both the metropolitan and rural areas. SARC doctors have also provided training to nurses and doctors in both the metropolitan and rural areas. It is hypothesised that the early collection of forensic evidence by the consistent and accurate use of the Preliminary Forensic Specimen Kits will lead to greater recovery of forensically significant material, greater identification of alleged perpetrators of sexual assault and improved patient care and outcomes. This study is being carried out in collaboration with the WA Police and PathWest Forensic Biology.
Chief Investigators
Dr Maureen Phillips MBBS Grad Dip Clinical Forensic Medicine Dr Debbie Smith MBBS Dr Catherine Nixon MBBS DRANZCOG FRACGP Grad Cert ClinicalForensic Medicine Liz Nathan BSc, Biostatistician
Associate Investigators
Mr Laurance Webb Senior Forensic Scientist and Team LeaderMajor Crime, Forensic Biology, PathWest Detective Senior Sergeant John Hindriksen Sex Assault Squad, WA Police
Support Staff
Rae Cummins, Administrative Assistant SARC
Major Sponsors
Women and Infants Research Foundation
Liz Nathan
Laurance Webb
John Hindriksen
47
annual report 2009
Publications
Publications in peer review scientific journals 2008 (July - December)
Blank,V., Hirsch, E., Challis, J., Romero, R. and Lye, S. Cytokine Signaling, Inflammation, Innate Immunity and Preterm Labour A Workshop Report, Placenta, 29:22, Supplement A, pp S102S104 (2008) Brameld, K.J., Dickinson, J.E., O'leary, P.C., Bower, C., Goldblatt, J., Hewitt, B., Murch, A. and Stock, R. First trimester predictors of adverse pregnancy outcomes, Australian and New Zealand Journal of Obstetrics and Gynaecology, 48: pp 529-535 (2008) Burrage, D., Green, L.R., Moss,T.J.M., Sloboda, D.M., Nitsos, I., Newnham, J.P. and Hanson, M.A. The carotid bodies influence growth responses to moderate maternal undernutrition in lategestation fetal sheep, British Journal of Obstetrics and Gynaecology, 115: pp 261-268 (2008) Chauhan, S.P., Magann, E.F., Doherty, D.A., Ennen, C.S., Niederhauser, A. and Morrison, J.C. Prediction of small for gestational age newborns using ultrasound estimated and actual amniotic fluid volume: Published data revisited, Australian and New Zealand Journal of Obstetrics and Gynaecology, 48: pp 160164 (2008) Cheah, F.C., Jobe, A., Moss,T.J., Newnham, J.P. and Kallapur, S.G. Oxidative stress in fetal lambs exposed to intra-amniotic endotoxin in a chorioamnionitis model, Pediatric Research, 63:3, pp 274-279 (2008) Cocciolone, R., Brameld, K., O'leary, P.C., Haan, E., Muller, P. and Shand, K. Combining first and second trimester markers for Down syndrome screening:Think twice, Australian and New Zealand Journal of Obstetrics and Gynaecology, 48: pp 492-500 (2008) Daniels, L., Gibson, R.A., Simmer, K.N.,Van dael, P. and Makrides, M. Selenium status of term infants fed seleniumsupplemented formula in a randomized dose-response trial, The American Journal of Clinical Nutrition, 88: pp 70-76 (2008) Dickinson, J.E., Shand, A.W. and D'Orsogna, L. Refractory Fetal Supraventricular Tachycardia and Obstetric Cholestasis, Fetal Diagnosis and Therapy, 24: pp 277-281 (2008) Doherty, D.A., Magann, E.F., Chauhan, S., O'Boyle, A., Busch, J. and Morrison, J. Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes, Australian and New Zealand Journal of Obstetrics and Gynaecology, 48: pp 286-291 (2008) Dunstan, J.A., Simmer, K.N., Dixon, G. and Prescott, S.L. Cognitive assessment of children at age 2 1/2 years after maternal fish oil supplementation in pregnancy: a randomised controlled trial, Archives of Disease in Childhood, Fetal and Neonatal Edition, 93:1, pp F45-50 (2008) Garefalakis, M. and Hickey, M. Role of androgens, progestins and tibolone in the teratment of menopausal symptoms: a review of the clinical evidence, Clinical Interventions in Aging, 3:1, pp 1-8 (2008) Gatford, K.L., Owens, J.A., Li, S., Moss,T.J.M., Newnham, J.P., Challis, J. and Sloboda, D.M. Repeated betamethasone treatment of pregnant sheep programs persistent reductions in circulating IGF-I and IGF-binding proteins in progeny, American Journal of Physiology:Endocrinology and Metabolism, 295: pp E170E178 (2008) Geddes, D.T., Langton, D.B., Gollow, I., Jacobs, L.A., Hartmann, P.E. and Simmer, K.N. Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effects on Milk Removal and Sucking Mechanism as Imaged by Ultrasound, Pediatrics, 122: pp e188e194 (2008) Hart, R.J., Hickey, M., Maouris, P. and Buckett,W. Excisional surgery versus ablative surgery for ovarian endometriomata, The Cochrane Collaboration, 23 April 2008:2 (2008) Hart, R.J. PCOS and infertility, Panminerva Medica, 50: pp 305314 (2008) Hart, R.J. Preservation of fertility in adults and children diagnosed with cancer, British Journal of Medicine, 337: pp a2045 (1045-1048) (2008) Henderson, J.J., Hartmann, P.E., Moss,T.J., Doherty, D.A. and Newnham, J.P. Disrupted secretory activation of the mammary gland after antenatal glucocorticoid treatment in sheep, Reproduction, 136: pp 649-655 (2008) Henderson, J.J., Hartmann, P.E., Newnham, J.P. and Simmer, K.N. Effect of Preterm Birth and Antenatal Corticosteroid Treatment on Lactogenesis II in Women, Pediatrics, 121: pp e92e100 (2008) Hickey, M. and Salamonsen, L.A. Endometrial structural and inflammatory changes with exogenous progestogens, Trends in Endocrinology and Metabolism, 19:5, pp 167-174 (2008) Hickey, M., Saunders, C., Partridge, A., Santoro, N., Joffe, H. and Stearns,V. Practical clinical guidelines for assessing and managing menopausal symptoms after breast cancer, Annals of Oncology, 19: pp 1669-1680 (2008) Hickey, M. and Hammond, I.G. What is the place of uterine artery embolisation in the management of symptomatic uterine fibroids, Australian and New Zealand Journal of Obstetrics and Gynaecology, 48: pp 360-368 (2008) Hickey, M., Doherty, D.A., Fraser, I.S., Sloboda, D.M. and Salamonsen, L.A. Why does menopausal hormone therapy lead to irregular uterine bleeding? Changes to endometrial blood vessels, Human Reproduction, 23:4, pp 912-918 (2008)
49
annual report 2009
Publications
(contd)
Hillman, N.H., Moss,T.J.M., Nitsos, I., Kramer, B.W., Bachurski, C.J., Ikegami, M., Jobe, A. and Kallapur, S.G. Toll-Like Receptors and Agonist Responses in the Developing Fetal Sheep Lung, Pediatric Research, 63:4, pp 388-393 (2008) Jobe, A., Hillman, N., Polglase, G.R., Kramer, B.W., Kallapur, S. and Pillow, J.J. Injury and Inflammation from Resuscitation of the Preterm Infant, Neonatalogy, 94: pp 190-196 (2008) Joyce, S.J., Cook, A.G., Newnham, J.P., Brenters, M., Ferguson, C.S. and Weinstein, P. Water Disinfection By-Products and Prelabor Rupture of Membranes, American Journal of Epidemiology, 168:5, pp 514-521 (2008) Kent, J.C., Mitoulas, L.R., Cregan, M.D., Geddes, D.T., Larrson, M., Doherty, D.A. and Hartmann, P.E. Importance of vaccum for breastmilk expression, Breastfeeding Medicine, 3:1, pp 11-19 (2008) Kramer, B.W., Albertine, K.H., Moss,T.J.M., Nitsos, I., Ladenburger, A., Speer, C.P., Newnham, J.P. and Jobe, A. Alltrans retinoic acid and intra-amniotic endotoxin-Mediated Effects on Fetal Sheep Lung, The Anatomical Record, 291: pp 1271-1277 (2008) Laurvick, C.L., Milne, E., Blair, E., de Klerk, N., Charles, A.K. and Bower, C. Fetal growth and the risk of childhood non-CNS solid tumours in Western Australia, British Journal of Cancer, 99: pp 179-181 (2008) Leuverink, E.M., Brennan, B.A., Crook, M.L., Doherty, D.A., Hammond, I.G., Ruba, S. and Stewart, C.J. Prognostic value of mitotic counts and Ki-67 immunoreactivity in adult-type granulosa cell tumour of the ovary, Journal of Clinical Pathology, 61:8, pp 914-919 (2008) Lim, S.C.B., Paech, M.J., Goy, R., Liu,Y., Zhang, G.,Yao, M. and Doherty, D.A. Pharmacokinetics and bioavailability of hydromorphone nasal spray, Journal of Pharmacy Practice and Research Volume, 38:3, pp 191-195 (2008) Magann, E.F., Doherty, D.A., Briery, C.M., Niederhauser, A., Chauhan, S.P. and Morrison, J.C. Obstetric characteristics for a prolonged third stage of labor and risk for postpartum hemorrhage, Gynecologic and Obstetric Investigation, 65: pp 201205 (2008) Makepeace, A.E., Bremner, A., O'Leary, P.C., Leedman, P.J., Feddema, P., Michelangeli,V. and Walsh, J.P. Significant inverse relationship between serum free T4 concentration and body mass index in euthyroid subjects: differences between smokers and nonsmokers, Clinical Endocrinilogy, 69: pp 648-652 (2008) McCormack, R.A., Doherty, D.A., Magann, E.F., Hutchinson, M. and Newnham, J.P. Antepartum bleeding of unknown origin in the second half of pregnancy and pregnancy outcomes, British Journal of Obstetrics and Gynaecology, 115: pp 1451-1457 (2008)
McDonald, S.J., Henderson, J.J., Faulkner, S., Evans, S.F. and Hagan, R. Effects of an extended midwifery postnatal support programme on the duration of breast feeding: A randomised controlled trial, Midwifery, doi:10.1016/j.midw.2008.03.001: (2008) Medeiros, L.R., Stein, A.T., Fachel, J., Garry, R. and Furness, S. Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis, International Journal of Gunecological Cancer, 18: pp 387-399 (2008) Metcalfe, S.A., Bittles, A.H., O'leary, P.C. and Emery, J.D. Australia: Public Health Genomics, Public Health Genomics, 12: pp 121-128 (2008) Milne, E., Laurvick, C.L., Blair, E., de Klerk, N., Charles, A.K. and Bower, C. Fetal growth and the risk of childhood CNS tumors and lymphomas in Western Australia, International Journal of Cancer, 123: pp 436-443 (2008) Molster, C., Charles,T., Samanek, A. and O'leary, P.C. Australian Study on Public Knowledge of Human Genetics and Health, Public Health Genomics, 12: pp 84-91 (2008) Moss,T.J., Knox, C.L., Kallapur, S.G., Nitsos, I., Theodoropoulos, C., Newnham, J.P., Ikegami, M. and Jobe, A. Experimental amniotic fluid infection in sheep: Effects of Ureaplasma parvum serovars 3 and 6 on preterm or term fetal sheep, American Journal of Obstetrics and Gynecology, 198: pp 122.e1-122.e8 (2008) Napolitano, P.G.,Wakefield, C.L., Elliott, D.E., Doherty, D.A. and Magann, E.F. Umbilical cord plasma homocysteine concentrations at delivery in pregnancies complicated by preeclampsia, Australian and New Zealand Journal of Obstetrics and Gynaecology, 48: pp 261-265 (2008) Newnham, J.P. and Simmer, K.N. Multiple courses of antenatal corticosteroids, The Lancet, 372: pp 2094 - 2095 (2008) Pedrana, G., Sloboda, D.M., Pérez,W., Newnham, J.P., Bielli, A. and Martin, G.B. Effects of Pre-natal Glucocorticoids on Testicular Development in Sheep, Anatomia Histologia Embryologia, 37: pp 352-358 (2008) Polglase, G.R., Hillman, N.H., Ball, M.K., Kramer, B.W., Kallapur, S.G., Jobe, A. and Pillow, J.J. Lung and Systemic Inflammation in Preterm Lambs on Continuous Positive Airway Pressure or Conventional Ventilation, Pediatric Research, 65:1, pp 67-71 (2008) Polglase, G.R., Hillman, N.H., Pillow, J.J., Cheah, F-C., Nitsos, I., Moss,T.J.M., Kramer, B.W., Ikegami, M., Kallapur, S.G. and Jobe, A. Positive End-Expiratory Pressure and Tidal Volume During Initial Ventilation of Preterm Lambs, Pediatric Research, 64:5, pp 517-522 (2008)
women and infants research foundation
50
Publications
(contd)
Polglase, G.R., Moss,T.J.M., Nitsos, I., Allison, B.J., Pillow, J.J. and Hooper, S.B. Differential effect of recruitment manoeuvres on pulmonary blood flow and oxygenation during HFOV in preterm lambs, Journal of Applied Physiology, 105: pp 603-610 (2008) Rampono, J., Simmer, K.N., Ilett, K.F., Hackett, L.P., Doherty, D.A., Elliot, R., Kok, C.H., Coenen, A. and Forman,T. Placental Transfer of SSRI and SNRI Antidepressants and Effects on the Neonate, Pharmacopsychiatry, 41: pp 1-6 (2008) Robinson, M., Oddy,W.H., Li, J., Kendall, G.E., de Klerk, N.H., Silburn, S.R., Zubrick, S.R., Newnham, J.P., Stanley, F.J. and Mattes, E. Pre- and postnatal influences on preschool mental health: a large-scale cohort study, Journal of Child Psychology and Psychiatry, 49:10, pp 1118-1128 (2008) Schulzke, S., Deeptha, K., Sinhal, S., Baldwin, D.N. and Pillow, J.J. Nasal Versus Face Mask for Multiple-Breath Washout Technique in Preterm Infants, Pediatric Pulmonology, 43: pp 858865 (2008) Shand, A.W., Bell, J.C., McElduff, A., Morris, J. and Roberts, C.L. Outcomes of pregnancies in women with pre-gestational diabetes mellitus and gestational diabetes mellitus; a populationbased study in New South Wales, Australia, 1998-2002, Diabetic Medicine, 25: pp 708-715 (2008) Showell, M.G., Brown, J.,Yazdani, A., Stankiewicz, M.T. and Hart, R.J. Antioxidants for male subfertility, Cochrane Database of Systematic Review, CD007411 DOI: 10.1002/14651858: (2008) Shynlova, O.,Tsui, P., Dorogin, A. and Lye, S. Monocyte Chemoattractant Protein-1 (CCL-2) Integrates Mechanical and Endocrine Signals That mediate Term and Preterm Labor, Journal of Immunology, 181: pp 1470-1479 (2008) Simmer, K.N., Patole, S.K. and Rao, S. Longchain polyunsaturated fatty acid supplementation in infants born at term., Cochrane Database of Systematic Reviews, CD000376:DOI:10.1002/14651858. pub 2 (2008) Simmer, K.N., Schulzke, S. and Patole, S.K. Longchain polyunsaturated fatty acid supplementation in preterm infants, Cochrane Database of Systematic Reviews, CD000375:DOI: 10.1002/14651858. pub3 (2008) Sloboda, D.M., Moss,T.J.M., Li, S., Matthews, S.G., Challis, J. and Newnham, J.P. Expression of glucocorticoid receptor, mineralocorticoid receptor, and 11‚-hydroxysteroid dehydrogenase 1 and 2 in the fetal and postnatal ovine hippocampus: ontogeny and effects of prenatal glucocorticoid exposure, Journal of Endocrinology, 197: pp 213-220 (2008)
Spilsbury, K., Hammond, I.G., Bulsara, M.K. and Semmens, J.B. Morbidity outcomes of 78577 hysterectomies for benign reasons over 23 years, British Journal of Epidemiology, 115: pp 1473-1483 (2008) Stewart, C.J.R., Brennan, B.A., Hammond, I.G., Leung,Y.C., McCartney, A.J. and Ruba, S. Intraoperative Assessment of Clear Cell Carcinoma of the Ovary, International Journal of Gynecological Pathology, 27: pp 475-482 (2008) Sweet, D.G., Huggett, M.T.,Warner, J.A., Moss,T.J.M., Kloosterboer, N., Halliday, H.L., Newnham, J.P., Kallapur, S.G., Jobe, A. and Kramer, B.W. Maternal Betamethasone and Chorioamnionitis Induce Different Collagenases during Lung Maturation in Fetal Sheep, Neonatalogy, 94: pp 79-86 (2008) Vani, S., Critchley, H.O.D., Fraser, I.S. and Hickey, M. Endometrial expression of steroid receptors in postmenopausal hormone replacement therapy users: relationship to bleeding patterns, Journal of Family Planning and Reproductive Health Care, 34:1, pp 27-34 (2008) Wan, E.W., Davey, K., Page-Sharp, M., Hartmann, P.E., Simmer, K.N. and Ilett, K.F. Dose-effect study of domperidone as a galactagogue in preterm mothers with insufficient milk supply, and its transfer into milk, British Journal of Clinical Pharmacology, 66:2, pp 283-289 (2008)
Publications in peer review scientific journals 2009 (January - June)
Aye, I. L. M. H., Singh A.T. and Keelan J.A. Transport of lipids by ABC proteins: Interactions and implications for cellular toxicity, viability and function. Chem-Biol Inter; 180(3): 327-339 (2009) Ball, MK, Jobe, AH, Polglase GR, Kallapur SG, Cheah F-C, Hillman NH and Pillow JJ. High and low body temperature during the initiation of ventilation for near-term lambs. Resuscitation, 80: 133-137 (2009) Burke C., Nathan E., Karthigasu K., Garry R and Hart R. Laparoscopic entry - the experience of a range of gynaecological surgeons Gynecol Surg 6:125–133 (2009). Challis J., Connor K., Matthews S., Lye S., Caniggia I., Petraglia F., Imperatore A., Sloboda D., Li S., Braun T. B, Li W. and Newnham J. Development of the Fetal Hypothalamic PituitaryAdrenal-Placental Axis: Implications for Postnatal Health. In: The Early Life Origins of Human Disease in Adults. Eds. John Newnham and Mike Ross, pp89-98 (2009)
51
annual report 2009
Publications
(contd)
Cheah F-C., Pillow J.J., Kramer B.W., Polglase G.R., Nitsos I., Newnham J.P., Jobe A.H. and Kallapur S.G. Airway inflammatory cell responses to intra-amniotic lipopolysaccharide in a sheep model of chorioamnionitis. Am J Physiol Lung Cell Mol Physiol, 296: L384-L393 (2009) Hickey M. Should the ovaries be removed or retained at the time of hysterectomy for benign disease? Human Reproduction Update. 2009 Sep 30. [Epub ahead of print] Hickey M and Agarwal S. Unscheduled bleeding in combined oral contraceptive users: focus on extended-cycle and continuous-use regimen. J. Fam Plann Repro Health Care (2009 in press) Hickey M. and Ambekar M. Abnormal bleeding in postmenopausal hormone users—What do we know today? Maturitas 63: 45-50 (2009) Hickey M., Karthigasu K. and Agarwal S. Abnormal uterine bleeding: a focus on polycystic ovary syndrome. Women’s Health; 5 (3): 313-324 (2009) Hickey M., Sloboda D.M., Atkinson H.C., Doherty D.A., Franks S., Norman R.J., Newnham J.P. and Hart R. The relationship between maternal and umbilical cord androgen levels and Polycystic Ovary Syndrome in adolescence: A prospective cohort study. J Clin Endocrinol Metab. 2009 Jun 30. [Epub ahead of print] Huang R.C., Mori T.A., Burke V., Newnham J., Stanley F.J., Landau L.I., Kendall G.E., Oddy W.H. and Beilin L.J. Synergy between adiposity, insulin ersistance, metabolic risk factors and inflammation in adolescents. Diabetes Care, 32(4): 695-701 (2009) Kallapur S.G., Nitsos I., Moss T., Polglase G., Pillow J., Cheah F.C., Kramer B., Newnham J.P., Ikegami M. and Jobe A.H. IL-1 Mediates Pulmonary and Systemic Inflammatory Responses to Chorioamnionitis Induced by LPS. Am J Respir Crit Care Med; 179(10): 955-961 (2009) Kramer B.W., Kallapur S.G., Moss T.J., Nitsos I., Newnham J.P. and Jobe A.H. Intra-amniotic LPS modulation of TLR signaling in lung and blood monocytes of fetal sheep. Innate Immunity; 15(2): 101-107. (2009) Kramer B.W., Kallapur S, Newnham J and Jobe A.H. Prenatal inflammation and lung development. Seminars in Fetal Neonatal Med., 14: 2-7 (2009) Lawrence A., Lewis L., Hofmeyr G.J.,Dowswell T. and Styles C. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews Issue 2. Art.No.: CD003934. DOI: 10.1002/14651858.CD003934.pub2. (2009)
Lewis L.N., Hickey M., Doherty D.A. and Skinner S R. How do pregnancy outcomes differ in teenage mothers? A Western Australian Study. MJA; 190 (10): 537-540 (2009) Moss T.J.M., Nitsos I., Knox C.L., Polglase G.R., Kallapur S.G., Ikegami M., Jobe A.H. and Newnham J.P. Ureaplasma colonization of amniotic fluid and efficacy of antenatal corticisteroids for preterm lung maturation in sheep. Am J Obstet Gynecol; 96.e1-96.e6. (2009) Newnham J.P. and Jobe, AH. Should we be prescribing repeated courses of antenatal corticosteroids? Seminars in Fetal and Neonatal Medicine; 14(3): 157-163 (2009) Newnham J.P., Pennell C.E., Lye S.J., Rampono J. and Challis JRG. Early life origins of obesity. Clin Obstet Gynaecol; 36:227244 (2009) Peate M., Meiser B., Hickey M. and Friedlander M. The fertilityrelated concerns, needs and preferences of younger women with breast cancer: a systematic review. Breast Cancer Res Treat; 116: 215-223 (2009) Polglase GR, Hooper SB, Gill AW, Allison BJ, McLean CJ, Nitsos I, Pillow JJ and Kluckow M. Cardiovascular and pulmonary consequences of airway recruitment in preterm lambs. J Appl Physiol, 106: 1347-1355 (2009) Robinson M., Mattes E., Oddy W.H., De Klerk N.H., Li J., MClean N.J., Silburn S.R., Zubrick S.R., Stanley F.J. and Newnham J.P. Hypertensive Diseases of Pregnancy and the Development of Behavioral Problems in Childhood and Adolescence:The Western Australian Pregnancy Cohort Study. The Journal of Pediatrics, 154: 218-24 (2009) Shub A,Wong C, Jennings B, Swain JR and Newnham J.P. Maternal periodontal disease and perinatal mortality. Australian and New Zealand Journal of Obstetrics and Gynaecology. 49(2): 130-136 (2009)
women and infants research foundation
52
Our Heartfelt Thanks
Major Supporters
The Foundation is proud to acknowledge and thank our major supporters who provide vital support to our research programs.
Lions
Lions Club International has been a stalwart supporter of the School of Women’s and Infants’ Health Research Laboratories since 2000.The generous donations received from Lions have enabled the Foundation to establish and equip a world class biomedical research laboratory based at King Edward Memorial Hospital. Their funding has supported the purchase and upgrading of vital laboratory equipment which has enabled us to attract students and staff and apply for national and international grants to fund research. In this way, each dollar received from the Lions has been amplified many times and helped to generate research findings that have been published and read around the world. Lions were the major funders of the establishment of an Image Analysis Suite in the laboratory; this facility is devoted to the microscopic analysis of tissue sections, cells and gels, all of which form a central part of many of the projects presently under way in the laboratories.
Channel 7 Telethon Trust
The Channel 7 Telethon Trust has been supporting the Women and Infants Research Foundation since 2003. Earlier this year Telethon committed funding to two projects each based on clinical research aimed at directly improving the health care for children in Western Australia. Both studies involve collaborations between clinical researchers in the Department of Obstetrics and Newborn Medicine at King Edward Memorial Hospital, and the Paediatric Medicine Department at Princess Margaret Hospital. Fetal Futures Project This study will follow up children who have been born with a major abnormality of their intestinal tract - a condition know as Gastroschisis, which involves the small bowel developing outside the abdomen. Most children survive but the effects on their bowel function, growth and development of other organ systems are unknown. Friendly bacteria to save premature babies from death and disease This project investigates the use of Probiotics to prevent lifethreatening death of the bowel in babies in the Neonatal Intensive Care Unit. Preliminary evidence suggests that early use of Probiotics may prevent necrotising enterocolitis which involves the death of the wall of the bowel resulting in gangrene within the abdomen. Thanks to the support we receive from Telethon we can offer hope and improved health to women and infants in conditions that were previously untreatable. (These studies are presented on pages 25 and 29 of this Report).
W H K Horwath
We gratefully acknowledge the pro bono provision of financial auditing and accounting services provided by W H K Horwath for the 2008/2009 financial year.
women and infants research foundation
54
With Thanks
To our volunteers and donors
At the heart of the Foundation are our volunteers and donors.Their kindness and commitment through donations of time and money is vital to our existence. Each of our volunteers performs an essential role, whether it is preparing hundreds of fresh rolls and sandwiches each day in the café, mailing baby’s first photos to new mums or re-stocking toys and baby clothes in our busy gift shop. As a mark of appreciation and in celebration of the Café/Gift Shop ten year anniversary, a special event was held in May 2009. All our volunteers were invited by our Patron, Mrs Julie Michael to Government House for a “Thank You” afternoon tea. Everyone received a Certificate of Appreciation and volunteers serving over ten years were awarded special personalised gifts. Four very special volunteers were selected by the Café/Shop Manager to receive special awards for their outstanding commitment and service:
Raie Bradshaw
Raie is our gift shop organiser; she works two full days a week and makes premature baby clothes and blankets for the shop in her spare time. She also assists with the stock taking, stock orders and takes the ward trolley around wards and clinics.
Win Froude
Win, our oldest volunteer, has been with us since opening in April 1999. Described affectionately as the best scullery maid in the world, she makes jams and pickles, runs our cake stalls, and arrives at the crack of dawn for duty. Win is 91 and truly amazing.
Betty Redmond L-R Volunteering is a family affair for Anne (grandmother), Beattie (mother) and Emma (daughter).
Betty has been part of our team for ten years, giving her time two days a week. She never goes home until the kitchen is organised and tidy, and will turn her hand to anything that has to be done. Betty rarely takes a day off from volunteering.
Leah McVeigh
Leah has been with us for over nine years and is known as “Queen of the Raffles” and “Queen of the Sellers”. Not a person gets past the café without being asked to buy a raffle ticket for research. She is dedicated to raising money for the Foundation and breaking all fundraising records.
(Below) L-R Leah McVeigh, Anne-Marie Weekes, Julie Michael, Raie Bradshaw, Betty Redmond
55
annual report 2009
With Thanks
(contd)
We are extremely grateful to everyone who has assisted the Foundation financially and in kind.Your contributions help us deliver our key aim in advancing research for women’s and infants’ health.
Volunteers
1999 Jill Berecry Raie Bradshaw Janice Braekevelt Kate Campbell Margaret Cooper Maria Crawford Gay Cruikshank Win Froude Maria Gapper Norma Garbin Diane Hoffman Jill Hunt Annette Lazberger Beryl Lawler Gaile Martyn Delphine Moore Betty Redmond Jan Schofield Marie Smith Isobel Sprivulis Julie Wilson 2000 Beverley Boyd Leah McVeigh 2001 Maggie Cooper Suzanne Draper Pam Imms Nina Leahy Kay Lodge Yvonne Neurauter Helen Roatch Helen Robertson 2002 Sylvia Webster 2003 Gillian Ball Elizabeth Hyde Rema Starina Joy Tillett 2004 Ann Carrington-Jones Corinne Kilbee Patricia McInnes 2005 Loretta Connery Janet Chang Tina Relf Pam Sulc 2006 Flora Amiel Meredith Cziesche Elaine Horton Beattie Ramel 2007 Sonje Bernardini Diana Fletcher Zoe Hewitt-Dutton Elizabeth Luzar Frances Lyons Robin Simon 2008 Fay Carmody Carol Darby Mary Muscroft Julie Nolan 2009 Aileen Swarbrick Vanessa Ryan
Donors for 2008 -2009
Thank you also to those donors who wish to remain anonymous. Alder, AL and CM Allgrove, Catherine Ayala, Philip Balfour,Yatiha Barker, Lynda Blackwell, Narelle Boardley, Graeme Bower, Caroline Buddha’s Light International Association of WA Burnaby,Valerie Burns, Andrea Carrington-Jones, Ann Channel 7 Telethon Trust Cimetta, Barbara City of Subiaco Cook, C Dawson, Craig and Julie Densure Dental laboratory Estate of the late Philippa MacGoun Farrington, Kim Forrest, Nicola French, Noel Gibson, Paul and Rachael Good, Alan Great Escape, Hillary’s Boat Harbour Hammer, Amy Harley, Peter Harris, Faamama Hartleys Limited Hartmann, Peter Hutchinson, Maureen Ibrahim, Bevelynn Isherwood, Karen Kaitse, Kelley Karczub, Anne Kopp, Janelle Lions District 201W1 Manning,Tershia Martin, Wayne & Sonya Maslin, Jack Maurice Meade Hair Salons Medalia, Susan H National Australia Bank Newnham, John Nurses and Midwives Board of WA Paech, Nichael Pearson,Tracy and Matthew Pennell, Craig Pillow, Jane Police & Nurses Credit Society Schofield, Lynette Seaman, Lynley Seymour, Sarah Stock, Rosanne Sutherland, Katherine The Alternative Centre The Great Escape Tusori, Henrietta Wembley Supa IGA Williams, Raelene Young, Aaron and Terri
women and infants research foundation
56
Research Support
External Research Grants Affiliated with the Women and Infants Research Foundation
The Women & Infants Research Foundation provides the infrastructure and funding to allow our researchers to successfully compete for external grants from organisations such as the National Health & Medical Research Council. Following is a list of competitive grants supported during the current financial year ending 30 June 2009:
National Health & Medical Research Council (NHMRC) (AUSTRALIA)
PREVENTION OF PRETERM BIRTH BY TREATMENT OF PERIODONTAL DISEASE DURING PREGNANCY. Investigators: J Newnham, D Doherty, J McGeachie (2005-2008 $894,750) THE FETAL AND EARLY CHILDHOOD ORIGINS OF PCOS: A PROSPECTIVE COHORT STUDY. Principal Investigator: M Hickey, R Hart, S Franks, D Sloboda, D Doherty, M Davies (2006-2008 $487,550) INTRAUTERINE UREAPLASMA INFECTION DURING PREGNANCY: FETAL EFFECTS AND CHARACTERISTICS OF UREAPLASMA PATHAGENICITY Principal Investigator: J Newnham (2007-2009 $507,750) DOES VARIABLE VENTILATION OFFER PHYSIOLOGICAL AND BIOLOGICAL BENEFITS FOR THE PRETERM LUNG Principal Investigator: J Pillow (2007-2009 $307,686) CLINICAL CAREER DEVELOPMENT AWARD T Moss (2004-2008 $520,000) CLINICAL CAREER DEVELOPMENT AWARD M Hickey (2006-2010 $305,375) PETER DOHERTY FELLOWSHIP: INFLUENCE OF INTRA-LUMINAL PRESSURE ON PULMONARY HAEMODYNAMICS IN FETAL SHEEP G Polglase (2007-2010 $274,000) $31,723 $79,673 $183,029 $106,783 $1,737 $70,218
$75,356
National Institute for Health (USA)
CONTROL OF MENSTRUAL BLEEDING DISTURBANCES IN WOMEN. Principal Investigators: I Fraser, L Salamonsen, J Findlay, M Hickey. (2003-2007 $287,409) CONSORTIUM GRANT - NEW MEDIATORS OF CLINICAL LUNG MATURATION. Investigators: A Jobe, M Ikegami, J Newnham. (2005-2008 USD$470,159) NEONATAL RESUSCITATION AND PRETERM LUNG INJURY. Principal Investigators: A Jobe, M Ikegami, J Pillow. (2005-2009 USD$283,829) POSTNATAL CONSEQUENCES OF FETAL INFLAMMATION. Principal Investigators: A.Jobe, J. Pillow, G Polglase, B. Kramer (2006-2008 USD$140,400) $90,614 $141,216 $177,060 $80,348
Raine Medical Research Foundation
THE EFFECTS OF ANTENATAL INFLAMMATION ON CARDIOPULMONARY HAEMODYNAMICS IN PRETERM LAMBS. Investigators: G Polglase, M Kluckow, S Hooper (2008-2009 $129,408) THE ABC’S OF PLACENTAL CELL DEATH AND DIFFERENTIATION. Investigators: JA Keelan, A Dharmarajan (2009-2010 $100,000) $65,834 $65,000
National Heart Foundation of Australia
THE EFFECTS OF ANTENATAL INFLAMMATION ON CARDIOPULMONARY HAEMODYNAMICS IN PRETERM NEONATAL LAMBS. Investigators: G Polglase, M Kluckow, S Hooper, J Pillow. (2008-2009 $122,886)
$46,542
Canadian Institutes of Health Research (CIHR)
GENE-ENVIRONMENT INTERACTIONS UNDERLYING THE DEVELOPMENTAL ORIGINS OF HEALTH & DISEASE. Investigators: S Lye, C Pennell (2006-2010) A MURINE MODEL TO INVESTIGATE THE MECHANISMS UNDERLYING DOHaD. Investigators: S Lye, C Pennell (2009-2010) $137,315 $18,758
The World Health Organization (WHO)
PRE-TERM BIRTH GENOME PROJECT CONSORTIUM. Investigators: C Pennell, G Ekman-Ordeberg, F Vadillo-Ortega, E Ha, D Olsen. (2008-2010) $393,589
women and infants research foundation
58
Sylvia & Charles Viertel Charitable Foundation
SENIOR MEDICAL RESEARCH FELLOWSHIP – UNDERSTANDING THE RELEVANCE OF BIOLOGICAL COMPLEXITY AND FRACTAL STRUCTURES FOR VENTILATION OF THE PRETERM LUNG. Principle Investigator: J Pillow (2007 – 2011 $975,000)
$214,016
Cincinatti Children’s Hospital
NEW MEDIATORS OF CLINICAL LUNG MATURATION. Investigators: A Jobe, M Ikegami, J Newnham, J Pillow $5,590
Department of Health - WA
MODELS FOR IMPROVED MATERNAL CARE FOR RURAL AND REMOTE ABORIGINAL WOMEN: EVALUATION OF CLINICAL BENEFITS AND COST-EFFECTIVENESS. Investigators: D Doherty, M Barrett, J Hornbuckle, A Larson, R Bradley, K Simmer, J Newnham (2008 - 2009 $119,300) EVALUATION OF THE INTRODUCTION OF UNIVERSAL CORD BLOOD GAS SCREENING TO W.A. MATERNITY UNITS. Investigators: C Pennell, C White, P McGurgan, J Henderson, D Doherty, J Newnham (2008 – 2009 $93,000)
$119,300 $42,000
Queensland Centre for Gynaecological Cancer
LAPAROSCOPIC APPROACH TO CARCINOMA OF THE ENDOMETRIUM: AN INTERNATIONAL MULTICENTRE RANDOMISED PHASE 3 CLINICAL TRIAL (LACE) Investigators:Y Leung, S Salfinger, A Obermair (2005 – 2010) $47,500
Peter MacCallum Cancer Institute
AUSTRALIAN OVARIAN CANCER STUDY (AOCS). Investigators: Y Leung, D Bowtell, A Green, A de Fazio (2001 – 2006) $33,053
Commercial Research Support
ORGANON (AUSTRALIA) PTY LTD – Evaluating the contraceptive efficacy, cycle control, safety and acceptability of a monophasic Combined Oral Contraceptive. Investigator: M Hickey (2006 – 2008) BAYER SCHERING PHARMA AG – Study of Oral Estradiol Valerate / Dienogest tablets for the treatment of dysfunctional uterine bleeding. Investigator: M Hickey (2006 – 2008) PFIZER AUSTRALIA PTY LTD – Evaluating the efficacy and safety of PD0299685 for the treatment of moderate to severe vasomotor symptoms associated with menopause. Investigator: M Hickey (2006 – 2007) GLAXO SMITH KLINE AUSTRALIA – Treatment of VMS study in post-menopausal women. Investigator: M Hickey (2007 – 2008) ASTRAZENICA PTY LTD – Evaluating the efficacy and systemic absorption of vaginal estradiol and estriol in postmenopausal breast cancer patients with symptomatic vaginal dryness using the aromatase inhibitor, Anastrozole. Investigator: M Hickey (2009 – 2012) FISHER & PAYKEL HEALTHCARE LTD – New Mediators of Clinical Lung Maturation. Investigators: A Jobe, M Ikegami, J Newnham, J Pillow NOVO NORDISK PHARMACEUTICALS – A trial comparing the efficacy and safety of insulin detemir versus human insulin, used in combination with insulin aspart as bolus insulin, in the treatment of pregnant women with type 1 diabetes. Investigator: D Graham (2008)
$1,500
$38,828
$ 4,110 $7,250
$ 94,600 $ 49,980
$11,500
Direct Research Expenditure by the Women and Infants Research Foundation
The Foundation provides financial support for researchers by direct funding through the Research Starter Grant Program, as well as infrastructure support for the external research grants outlined above. As detailed in the Foundation’s Financial Statements, the total “monetary” value of this support for the current financial year was: $1,112,756
Total Research Support for 2008 / 2009
$3,546,778
59
annual report 2009
Financial Statements
Women & Infants Research Foundation Inc. Income Statement for the year ended 30 June 2009
2009 $
Revenue Depreciation Expenses Research Grants Approved Other Research Expenses Administration Expenses Trading Activities - Cost of Goods Sold and Other Expenses Finance Costs Loss on Disposal of Financial Assets Impairment Loss on Financial Assets Profit / (Loss) Before Income Tax Income Tax Expense Profit / (Loss) From Ordinary Activities for the Year 3,073,054 -104,152 -101,497 -1,854,691 -266,693 -1,054,296 -6,996 -649,836 -732,888 -1,697,995 -1,697,995
2008 $
2,603,557 -100,196 -116,057 -936,396 -249,626 -986,781 -6,522 207,979 207,979
A full copy of the Foundation’s audited general purpose financial report for the year ended 30 June 2009 is available at www.wirf.com.au
Women & Infants Research Foundation Inc. Balance Sheet as at 30 June 2009
2009 $ 2008 $
1,576,160 184,626 22,756 42,432 1,825,974
CURRENT ASSETS
Cash and Cash Equivalents Trade and Other Receivables Inventories Other Current Assets Total Current Assets 2,154,616 315,150 37,937 34,233 2,541,936
NON-CURRENT ASSETS
Financial Assets Property, Plant and Equipment Total Non-Current Assets Total Assets 2,814,050 599,136 3,413,186 5,955,122 4,772,021 493,015 5,265,036 7,091,010
CURRENT LIABILITIES
Trade and Other Payables Short Term Provisions Total Current Liabilities 1,639,973 86,833 1,726,806 1,552,786 80,031 1,632,817
NON-CURRENT LIABILITIES
Long Term Provisions Total Non-Current Liabilities Total Liabilities Net Assets 29,624 29,624 1,756,430 4,198,692 21,904 21,904 1,654,721 5,436,289
EQUITY
Retained Earnings Reserves Total Equity 3,585,803 612,889 4,198,692 5,307,162 129,127 5,436,289
women and infants research foundation
60
Women & Infants Research Foundation Western Australia
Carson House King Edward Memorial Hospital 374 Bagot Road Subiaco Western Australia 6008 Postal address PO Box 134 Subiaco Western Australia 6904 Telephone (08) 6458 1437 Facsimile (08) 6458 1642 Website www.wirf.com.au Email info@wirf.com.au

Published under a Creative Commons License By attribution, non-commercial
AttachmentSize
ar2009.pdf3.36 MB