3rd fact

There were 452 new cases of gynaecologic cancers in WA in 2010 and this is projected to rise to 517 new cases by 2015.

2010 Annual Report

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science for human health
Annual Report
Women and Infants Research Foundation
Affiliated with The University of Western Australia and King Edward Memorial Hospital
C ontents
Overview of Research
Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Patron’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Prime Areas of Research . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Organisational Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Board of Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Chairperson’s Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Executive Director’s Report . . . . . . . . . . . . . . . . . . . . . . . . .6 Governance Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Stars Events 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Grant Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 The Professor Gordon King Scholarships . . . . . . . . . . . . . .11 RESEARCH UNITS Biostatistics and Research Design Unit . . . . . . . . . . . . . . .13 Women and Infants Research Foundation/Lotterywest Perinatal Research Laboratories . . . . . . . . . . . . . . . . . . . . .14 Women and Infants Health Research Laboratories . . . . . .15 Perron Rotary Express Milk Bank . . . . . . . . . . . . . . . . . . . .16 RESEARCH REPORTS The Smile Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 The Raine Study From 1989 to 2010 - still going strong . . . . . . . . . . . .21 Genetic Epidemiology Group . . . . . . . . . . . . . . . . . . . .22 “Challenge Me” Study . . . . . . . . . . . . . . . . . . . . . . . . . .23 Fetal and Childhood Origins of Polycystic Ovary Syndrome (PCOS) . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 The Fetal and Early Life Origins of Impaired Testicular Function . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Fetal Futures Program . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 The Preterm Genome Project . . . . . . . . . . . . . . . . . . . . . .28 Substance Abuse in Pregnancy . . . . . . . . . . . . . . . . . . . .30 Role of Umbilical Cord Blood Gas and Lactate Analysis in Perinatal Care . . . . . . . . . . . . . . . . . . .31 Placental Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Anaesthesia and Pain Relief . . . . . . . . . . . . . . . . . . . . . . . .33 Maternity Care for Rural and Remote Aboriginal Women in WA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Family Vascular Risk Factors in the Prediction of Pre-eclampsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Breastfeeding Research . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Neonatal Respiratory Medicine and Physiology . . . . . . . . .38 Impact of Caffeine and Maturation on Respiratory Control in Preterm Infants . . . . . . . . . . . . . . . . . . . . . . . . .39 Nutrition for the Newborn Probiotics And NeonaTes Study (PANTS) . . . . . . . . . .40 PeaNut Trial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Intravenous Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . .43 Australian Ovarian Cancer Study (AOCS) . . . . . . . . . . . . .44 Ovarian Cancer – Patterns of Care . . . . . . . . . . . . . . . . . .45 Laparoscopic Approach to Carcinoma of the Endometrium (LACE) . . . . . . . . . . . . . . . . . . . . . . . . . .46 Evaluation of Preliminary Forensic Specimen Kits in Recent Sexual Assault . . . . . . . . . . . . . . . . . . . . . . .47 Our Heartfelt Thanks . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 Research Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Financial Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Our Mission
To conduct, support and promote high quality research 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.
P s Message atron’
Friends of the Women and Infants Research Foundation Western Australia
Patron’s Message
It is a great privilege to be Patron of the ‘Friends of the Women and Infants Research Foundation’ in Western Australia. In this position, I have continued to learn more about the work of the Foundation and the vital role of the Friends in supporting the Foundation’s significant research work.
The funds raised through the efforts and generosity of the staff and volunteers, helps make much of the research possible. To remain at the forefront of women’s and infants’ health, research continues into the health issues that affect newborns, reproduction and women at all ages. The work of the Friends provides a valuable service that is selfless and inspiring, offering friendship, kindness and a helping hand where it is needed. The commitment and efforts of the staff and volunteers goes a long way towards improving the lives of others. It really is a wonderful example of serving the community. I am very proud to be part of this important organisation. My thanks to all for their efforts that allow research to improve the health of women and infants in our community.
medical for
human health
Honourary Life Members:
Mrs Julie Michael
Patron September 2010 Mrs Janet Holmes à Court Mr John Rawlinson Emeritus Professor Con Michael
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
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
Lotterywest Perinatal Research Laboratories (UWA Campus)
Women and Infants Research Foundation / The University of Western Australia Laboratories
Breastfeeding Centre
Board of Management
Honourary Board of Management
Ms Anne Payne
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
Mr Graeme Boardley
Executive Director of Midwifery and Nursing King Edward Memorial Hospital
Andrea Burns Graeme Boardley
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
Jim Davies Nicola Forrest
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
Peter Hartmann
Peter Hawkins
Ms Jann Rowley
Professor Jane Pillow
Professor, School of Women's and Infants' Health, UWA Viertel Senior Medical Research Fellow Consultant Neonatologist, Women's and Newborns' Health Service
Gerald Major
Craig Pennell
Jann Rowley
Jane Pillow
Chairperson’s Report
“The seventy women and men who work for us as volunteers have continued to make an invaluable contribution to the lives of the Hospital and the Foundation. Without their generosity, we could not hope to be so successful.“
Welcome to the 2009-10 Annual Report of the Women and Infants Research Foundation. The Report describes many of the achievements and activities of the Foundation over the last year, together with descriptions of the organisation as a whole. On behalf of the Board, I hope that you find reading this Report both educational and interesting.
We find ourselves at a most challenging time in the history of health care. Never has the standard of health care been so high, but never has it been so demanding and expensive. Sadly, the challenge of preterm birth has yet to be conquered and in most communities, including our own, the rate of preterm birth continues to rise. The Foundation holds prevention of prematurity, and care for those infants born too early, amongst its highest priorities. The Board is also keen to promote many new areas of research, and this year has been pleased to support new trials in the field of cancer research As for most similar organisations, the recent economic problems have presented new challenges. The Board is grateful to the Finance Committee, chaired by Mr Alan Good, which has continued to provide us with sound investment strategies. We also are fortunate to have a diversified income base, with valuable funds provided by our businesses and donations. The seventy women and men who work for us as volunteers have continued to make an invaluable contribution to the lives of the Hospital and the Foundation. Without their generosity, we could not hope to be so successful. Many organisations have provided ongoing support throughout the year. I would like to express appreciation of the Board to Channel 7 Telethon Trust, Lions District 201W1, United Community Foundation, the ABN Foundation, Kmart and Cash and Carry, as well as our donors, many of whom wish to remain anonymous. An organisation can only be as good as the people who make it function. I would like to thank Professor John Newnham who is our Executive Director; Professor Dorota Doherty who is Deputy Director and heads the Biostatistics and Research Design Unit; Professor Jeffrey Keelan and Dr Matt Kemp who head our two main laboratories; Mrs Tina Williams who is our Marketing and Development Manager; Mrs Anne-Marie Weekes who heads the Café and Gift Shop; Ms Andrea Cole who is our senior accountant; Ms Julie Rutgers who heads the First Photo Business; Mrs Chris Spencer who is the Foundation’s secretary; and Mr Tony Smith who supports our information technology. Finally, I would like to thank the many researchers and clinicians who support the Foundation and help us to achieve our goals. Our aim is to make discoveries that will improve the health of the women and infants of Western Australia and elsewhere. The pages that follow outline how the Foundation is being successful in the pursuit of that goal.
Anne Payne
Chairperson’s Report
Executive Director’s Report
Executive Director’s Report
“For the 2400 children born prematurely in Western Australia each year, the Foundation continues to foster and support research that makes their journey into the world even safer.”
This year’s Annual Report outlines the many areas of research and development that have flourished throughout the year. Some of the organisation’s major projects have been completed this year, others have been commenced, and many continue their long history. These activities are increasing and highlight the growth and development of the Foundation and its people, and the valuable contributions that are being made to the health care of women and their babies.
One of the Foundation’s major research goals is to discover strategies to prevent preterm birth. This complication affects more than 8% of all pregnancies in Western Australia and the percentage is increasing in both our population and most Western countries. We have recently completed one of the largest controlled research trials to have been conducted in Western Australia answering the question of whether preterm birth may be prevented by treating periodontal (gum) disease. The trial was called The Smile Study and involved more than 3000 pregnant women. Recruitment and examinations were conducted over seven sites within the metropolitan area of Perth. The fact that this large study could be completed on-time and on-budget is testimony to the commitment of the women of Western Australia to contribute to medical research and to the skill and enthusiasm of our researchers and clinicians. The results of the study are outlined later in the Report. For the 2400 children born prematurely in Western Australia each year, the Foundation continues to foster and support research that makes their journey into the world even safer. Under the leadership of Professor Jane Pillow, a new method of providing respiratory support for very preterm infants has been introduced. For this purpose, the Foundation successfully raised funds to purchase jet ventilators, the first of their type in Western Australia. This project was known as the “Angel Breath Campaign” and we are grateful to everyone who gave their support and made this venture so successful. This new treatment adds to the many ways in which preterm babies can receive respiratory support without causing injury to their fragile new lungs. Ongoing research will provide even more advances for the care of our smallest and sickest newborns. One of the greatest advances in medical research in recent years has been an increasing appreciation that many illnesses result not just from a genetic predisposition or the environment, but from an interaction between the two. Associate Professor Craig Pennell has taken the lead in placing the Foundation in a central role worldwide in studies of the way that our genes interact with our environment before and soon after birth. In collaboration with the World Health Organization and scientists in many other countries, samples from women in preterm labour come to Western Australia for detailed genetic analysis. These studies are helping us to understand how some women are genetically at risk of giving birth too early. It is our hope that we may develop strategies by which these women may benefit from lifestyle modifications and interventions that counteract this predisposition. To conduct research in modern genetics requires increasingly complex and expensive laboratory equipment. We are grateful to Channel 7 Telethon for supporting our application to purchase a DNA extraction robot. In essence, this robot extracts DNA from a large number of samples and can operate 24 hours each day, enabling us to conduct much larger genetic studies than before. One of the most important functions of any research organisation is to identify and promote the next generation of researchers. The Foundation has a broad program for this purpose. For those students embarking on a PhD thesis, we provide top-up funding and full Scholarships; for those in the early stages of their career we provide Starter Grants; and for those who are more established we provide a limited number of Capacity Building Grants. Each year we hold an event to showcase our young researchers, called the Rising Stars Symposium. (See our Rising Stars page 9). Last year, the Board introduced new Scholarships in honour of Professor Gordon King. Professor King was both the inaugural Professor of Obstetrics and Gynaecology and the inaugural Dean of the Faculty of Medicine at The University of Western Australia. He came to Perth in 1956, previously being Professor of Obstetrics and Gynaecology in Hong Kong. This year, Professor Gordon King Scholarships were awarded to four students, each of whom is a medical student taking a year off from clinical training to conduct research. Details of their research programs can be found later in the Report. It is our expectation that students who gain experience in research
during their medical training will be well-equipped if they wish to pursue leadership positions in our health care system in future years. The global financial crisis over recent years has provided challenges for the Foundation, as it has for all similar research organisations. We have been most fortunate however to have a diversified income base, with funds for infrastructure provided by our businesses and donations, and funds for specific research projects provided largely from external competitive granting bodies. All members of the organisation, and the people whose health care we are endeavouring to improve, should be grateful to the many people whose tireless efforts ensure the Foundation’s financial security. These people include Mrs Tina Williams our Marketing Manager; Mrs Anne-Marie Weekes who heads the Café and Gift Shop; Ms Julie Rutgers who heads the First Photo Business; and Mr Alan Good who chairs our Investment Committee. Of all, we should be most grateful for the many women and men who work as our volunteers and who are so generous in contributing their time and expertise. On a personal note, I would also like to thank the many people whose commitment and professional expertise underpins the success of our organisation. These include Professor Dorota Doherty who heads the Biostatistics and Research Support Unit; Professor Jeffery Keelan who heads the WIRF/UWA
Laboratories; Dr Matt Kemp who heads the Perinatal Research Laboratories on the UWA Crawley campus; Dr Ben Hartmann who heads the Human Milk Bank; Mr Shaofu Li who is our Laboratory Manager; Ms Andrea Cole who is our accountant; Mrs Claire Williams who is our book keeper; Mr Tony Smith who provides support in information technology; and Mrs Christine Spencer who is the Foundation’s secretary. At the head of this organisation is the Board, providing leadership, strategic direction and governance. I would like to thank all the Board members for their ongoing support, in particular Anne Payne who is the Chair and Mr Alan Good who is the Deputy Chair. In collaboration with King Edward Memorial Hospital and The University of Western Australia, the Foundation continues to grow and prosper. This productivity is vital for us to continue providing the highest possible health care for women and babies in Western Australia and elsewhere. Further details of the activities of the Foundation during the year can be found in the following pages. I hope you find reading them beneficial and enjoyable.
Winthrop Professor John Newnham
Executive Director
Andrea Cole
Christine Spencer
Claire Williams
Anne-Marie Weekes
Julie Rutgers
Tina Williams
Tony Smith
Dawn Masilamony
Executive Director’s Report
Governance Statement
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.
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.
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 Newborns’ Health Service and / or the Human Research Ethics Committee and Animal Ethics Committee of The University of Western Australia.
Winthrop Professor Peter Hartmann Professor of Biochemistry The University of Western Australia
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
Risk Management
All employees and volunteers of the Foundation undergo criminal screening and blood tests in compliance with the requirement of the Child and Adolescent Health Service (CAHS), irrespective of whether they have direct contact with children or not.
Financial Reporting
The Foundation’s financial year ended on 30th of June 2010. 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 30th of June 2010 are available on www.wirf.com.au
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.
Stars Events 2009
WIRF was thrilled to relaunch the Stars Event and Rising Stars Symposium in September 2009. These esteemed events are the Foundation’s opportunity to showcase the ground-breaking and vital work that is undertaken by its researchers in women’s and infants’ health and to celebrate their research achievements.
Rising Stars
The Rising Stars event is a celebration of some of WA’s top emerging medical researchers. Seven researchers presented their latest discoveries in short, sharp research reviews to an audience of 100 people at Matilda Bay Restaurant. Our 2009 Rising Stars are listed as follows:
Stars Event
The Stars Event was held at Subiaco Arts Centre. Our theme explored and discussed “Recent Advances in Pregnancy Research, Small Steps or Giant Leaps for Womankind”? Three experts presented their latest research findings:
Implications for fetal cholesterol delivery/removal.’
Irving Aye - PhD Student, School of Women’s and Infants’ Health, UWA
‘The influence of the uterine environment on pulmonary vascular development and function in preterm lambs’
Dr Graeme Polglase - Research Fellow, School of Women’s and Infants’ Health, UWA
‘The placenta: fetal firewall or porous portal?’
Professor Jeffrey Keelan Director, Women’s and Infants’ Health Research Laboratories (UWA/WIRF)
‘Prediction of survival in extreme preterm premature rupture of membranes (PPROM)’
Dr Tamara Hunter - Obstetric Registrar, Women and Newborn Health Service, KEMH
‘David meets Goliath: The new frontiers of prenatal ultrasound’
Professor Jan Dickinson, Maternal Fetal Medicine Head School of Women’s & Infants’ Health/UWA
‘High frequency jet ventilation for the management of respiratory distress syndrome’
Dr Gabby Musk - PhD Student, School of Women’s and Infants’ Health, UWA
Keynote Presentation
‘Maternal Immunity – implications for pregnancy and autoimmune disease’
VISITING PROFESSOR Jonathan Morris Professor of Obstetrics and Gynaecology, University of Sydney Following the presentations our experts participated in an informative and revealing panel discussion. The evening concluded with a cocktail exhibition with information displays by Baxter, Bayer and WIRF. We thank our 2009 Stars Event sponsors - KEMH Postgraduate Medical Education, Bayer Healthcare and Baxter Healthcare.
‘New insights on lung growth and lung function of preterm infants’
Dr Sven Schulzke - Neonatal Consultant, Women and Newborn Health Service, KEMH & PMH
‘Breastfeeding influences and outcomes for healthy term and sick/preterm infants’
Sharon Perrella - Nurse Researcher, Women and Newborn Health Service, KEMH, PhD Student, School of Biomedical, Biomolecular and Chemical Sciences, UWA.
‘Implanon as a contraceptive of choice for teenage mothers’
Lucy Lewis - PhD Student, School of Women’s and Infants’ Health, School of Paediatrics and Child Health, UWA
Panel discussion
Rising Stars presentations
Stars Events
Grants Funding
Grants Funding
Starter Grant Funding
To fulfil our mission of promoting high quality research and fostering new researchers WIRF provides four types of grant funding and scholarships.
Starter grants are predominately for new investigators embarking on their research career. Grants are for a maximum of $15,000 and awarded for a period of 12 months. Five Starter Grants were awarded in 2009/10:
“Effectiveness of simultaneous or sequential pumping of breast milk”
Dr Jacqueline C Kent Amount funded: $12,750 Brief Description Mothers who pump their breast milk need the milk removal to be comfortable, convenient, efficient and effective. Previous studies have found that simultaneously pumping both breasts saves time and may remove more milk than sequentially pumping the breasts. However, the finding of increased yield of milk is unconfirmed. We have developed techniques that can determine if simultaneous pumping affects the time taken to achieve a milk ejection, the number of milk ejections, and the amount of milk removed during each milk ejection.
“Provision of post operative analgesia for pregnant research sheep using a controlled release device for medetomidine in the abdominal cavity”
Dr Gabrielle C Musk, Dr Graeme P Polglase, Dr Fraser R Murdoch Amount funded: $13,785 Brief Description Post operative pain relief in pregnant sheep is difficult as many of the drugs available may be associated with side effects which threaten the viability of the fetus. We intend to investigate a new administration method for medetomidine: a drug loaded small pump which is placed in the abdomen at the end of the surgical procedure which these ewes are subject to as part of an existing study. This pump will deliver drug continuously into the abdominal cavity and should be readily absorbed into the blood stream and provide analgesia for these sheep without harming the fetus.
“The role of cytokeratins in fetal lung development and preterm respiratory disease”
Dr Matthew W Kemp Amount funded: $15,000 Brief Description In the same way the roof of a house is supported by beams that resist damage from the elements, cells in the body depend on an internal ‘scaffold’ of proteins to provide strength. Proteins called cytokeratins are thought to play an important structural role in our lungs. In order to develop better treatments, we hope to investigate how cytokeratin ‘scaffolds’ grow as the lung develops and how they react when a premature lung is exposed to a ‘postnatal’ environment.
“Dose equivalence of metaraminol and phenylephrine to prevent hypotension”
Dr Nolan McDonnell, Professor Michael Paech Amount funded: $14,277 Brief Description Drugs called vasopressors are frequently given to maintain blood pressure during caesarean section under spinal anaesthesia. Falls in blood pressure can have adverse effects on the mother and the baby. Phenylephrine and metaraminol are considered the most suitable drugs for this but we do not know which is better. In this study we will determine the relative potency of each drug so that in a future study they can be compared accurately.
“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”
Dr Girish C Deshpande, Winthrop Professor Karen Simmer Amount funded: $13,700 Brief Description Preterm neonates (<30 weeks) need intravenous nutrition including fat. Currently used olive oil based lipid emulsion (Clinoleic®) is rich and has higher omega-6: omega-3 ratio due to the lower omega-3 PUFAs content (9:1) which may not be ideal. This study will test if new SMOFlipid® with ideal ratio of omega-6: omega-3 ratio (2.5:1) is safe and effective in preterm neonates to supply adequate omega-6 LCPUFA important for vision and neurodevelopment of preterm neonates.
Grants Funding continued
PhD Scholarships (Top up funded)
The PhD Scholarships are a component of a wider strategy designed to nurture and develop promising researchers. The applicants must meet the requirements for candidature for the degree of Doctor of Philosophy by The University of Western Australia, School of Post Graduate Studies. The maximum funding is $12,500 (matched by UWA) for three years with a possible extension of 12 months.
“Effect of milk composition and milk volume on gastric emptying in the preterm infant“
Sharon Perrella Amount funded: $12,500 per annum for three years with a one-off $3000 travel allowance.
“Genome-wide search for the genetic determinants of fetal growth”
Dr Scott W White Amount funded: $5,000 per annum for three years with a oneoff $3,000 travel allowance.
Professor Gordon King
“Breastfeeding and reduced obesity risk: What goes wrong when breastfeeding stops?”
Foteini Hassiotou Amount funded: $12,500 per annum for three years with a one-off $3,000 allowance for consumables and travel.
Bachelor of Medical Science Scholarships in honour of Professor Gordon King
WIRF introduced this new scholarship in 2009 in honour of Professor Gordon King. Professor King was the inaugural Dean of the Medical School of The University of Western Australia and the first Professor of Obstetrics and Gynaecology. The purpose of the Gordon King Scholarship is to assist medical students who take a year out of their studies to pursue research, achieving a Bachelor of Medical Science degree (B Med Sci).
Capacity Building Grants
Capacity Building 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. Grants are a maximum of $35,000 per year for 3 years which is subject to satisfactory performance at yearly reviews.
Owen McWilliam was the inaugural recipient in 2009. His research focussed on identifying a link between preterm birth, caused by preterm prelabour rupture of membranes, and generic variations in maternal and fetal DNA. Amount funded: $6,000 for one year.
“The Preterm Birth Genome Project”
Associate Professor Craig E Pennell and Associate Investigator Dr Jennifer Henderson Amount funded: $35,000 per year (for three years beginning 2008) 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.
“Investigation of the placental permeability and uptake of drug-carrying nanoparticles”
Vinith Menezes Amount funded: $6,000 for one year.
“The outcome of aeromedical transfer of women in preterm labour”
Natalie Akl Amount funded: $6,000 for one year.
“The role of cytokeratins in fetal lung development and preterm respiratory disease”
Thomas Cox Amount funded: $6,000 for one year.
Grants Funding
Biostatistics and Research Design Unit
The role of the Biostatistics and Research Design Unit is to provide biostatistical collaboration, consultation and quantitative resources for research conducted at King Edward Memorial Hospital and affiliated institutions. The Unit members participate in a range of activities including consultation on design and analysis for small pilot projects, development of study design for major projects, assistance and advice on database construction and management, and collaboration on large projects where outcomes measurement and statistical analysis considerations are non-trivial.
Our involvement in research projects conducted on campus ranges from short-term consultations to ongoing long-term collaborations on studies supported by research funding. A short-term statistical consultation may require one or two sessions on designing experiments, formulating initial plans for data collection, or advice on statistical methodology for data analysis. These short-term consultations often develop into ongoing longer term collaborations. Research studies supported by funding benefit from ongoing statistical collaboration. In these studies we are often involved from conception to completion, including dissemination of results in peer-reviewed scientific journals. During the study design we are often involved in grant proposal writing that initially includes formulation of primary and secondary objectives, hypothesis formulation and testing, sample size estimation, planning for study monitoring and inclusion of interim analyses. Our involvement in the planning of experiments may also include the development of appropriate statistical approaches and computational algorithms to meet the needs that are project specific. At the design stage, we also 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. We assist with the determination of sample sizes for the evaluation of the primary objectives and detection of clinically relevant alternative hypotheses. In ongoing large scale studies we often participate in various aspects of data management such as design of data collection forms, design and maintenance of databases and facilitation of data entry. We often monitor study progress and quality assurance by collating interim data summaries and we perform statistical analyses upon the study completion. We also contribute to the dissemination of study results by performing analysis of completed studies, preparing statistical reports and, when needed, writing of the statistical sections for research manuscripts. Last year our Unit was involved in collaborative research with investigators working at King Edward Memorial Hospital, The Institute for Child Health Research and all four Western Australian Universities. 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, Jeffrey Cannon, Liz Nathan, Dorota Doherty and Angela Jacques
“Our involvement in research projects conducted on campus ranges from short-term consultations to ongoing long-term collaborations on studies supported by research funding.”
Research Units
Research Units
The Women and Infants Research Foundation / Lotterywest Perinatal Research Laboratories
Overview of Research
Housed within the Large Animal Facility on The University of Western Australia’s Crawley Campus, the WIRF / Lotterywest Perinatal Research Laboratories have continued to play a critical role in preterm birth and perinatal medicine studies undertaken by the Foundation over the past research year.
2009 – 2010 has seen continued heavy use of the Perinatal Research Laboratories. Research programmes funded by a diverse set of governmental and philanthropic organisations including the National Health and Medical Research Council (NHMRC, AU), the National Institutes of Health (NIH, USA), the Women and Infants Research Foundation (WIRF, AU), the Ramachiotti Foundations (AU) and the Financial Markets Foundation for Children (FFC, AU) have depended on WIRF facilities for a host of analytical and developmental studies. With ongoing support from the Women and Infants Foundation, these laboratories are uniquely placed to allow us to continue our studies into preterm birth and perinatal health. In doing so, the support of the Foundation allows us to continue to make significant contributions to the improvement of the health of women and their babies. In closing, I would like to acknowledge the hard work of my predecessor Dr Graeme Polglase who has now returned to Melbourne and thank my colleagues within the Foundation and the School of Women’s and Infants’ Health for their support and enthusiasm during the past twelve months. Dr Matthew W. Kemp Research Fellow UWA School of Women’s and Infants’ Health Manager WIRF / Lotterywest Perinatal Research Laboratories
Funding bodies
National Institutes of Health (NIH, USA) National Health and Medical Research Council (NHMRC, AU) Women and Infants Research Foundation The Ramachiotti Foundations The Financial Markets Foundation for Children
WIRF / School of Women’s and Infants’ Health The University of Western Australia Winthrop Professor John P. Newnham MD FRANZCOG Dr Ilias Nitsos BSc (Hons) PhD Dr Masatoshi Saito MD PhD Mr Thomas Cox BMedSc Hons Candidate Dr Matt Kemp PhD Mr Shaofu Li PhD Candidate Dr Gabby Musk BVMS PhD Candidate Professor Jane Pillow FRACP PhD Dr Clare Berry PhD Dr Yong Song PhD Ms Tina Lavin BSc Cincinnati Children’s Hospital Medical Centre, USA Professor Alan Jobe MD PhD Dr Suhas Kallapur MD Dr Noah Hillman MD Dr Claire Chougnet PhD Maastricht University, The Netherlands Dr Boris Kramer MD Ms Jennifer Collins PhD Candidate Monash University Dr Graeme Polglase PhD Queensland University of Technology Dr Christine Knox PhD
Working within a framework of improving perinatal health and preventing preterm birth, these projects are pursuing research objectives that include: the development of neutralising antibody therapies for intrauterine inflammation; the investigation of the fetal skin as an origin of fetal inflammation and nosocomial infection, fetal respiratory and neurological development; and the enhancement of neonatal outcomes following supportive ventilatory treatment. A major thrust of our ongoing research programme relates to the addition of detailed molecular analyses of both human and experimental animal tissues to our existing gross anatomical and physiological studies. We are delighted to announce significant progress in our aim to upgrade the Perinatal Research Laboratories to allow for work of this nature to be undertaken. Having been recently awarded several grants (including a grant from WIRF) we have purchased several significant items of equipment including a high-speed centrifuge, biohazard cabinet, cell culture incubator, a thermocycler, and DNA / protein electrophoresis equipment. This enhanced capacity will be of particular use to our two new PhD students, Mr Tom Cox from Perth and Dr Zhang Li from Beijing, both of whom will be undertaking research into the inflammatory / infectious mechanisms underlying preterm birth and its associated perinatal complications.
Women and Infants Health Research Laboratories
The Women and Infants Health Research Laboratories (WIHRL) are located on the second floor of King Edward Memorial Hospital. Within the spacious laboratories are separate RNA, DNA, image analysis and tissue culture laboratories, plus a large general biomedical laboratory and freezer storage facilities. They are jointly owned and managed by the Foundation and The University of Western Australia’s School of Women’s and Infants’ Health. Funds from the Foundation support the purchasing of core consumables and reagents, and the maintenance and servicing of equipment.
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, four Postdoctoral Fellows, three Research Assistants and one Research Midwife. The School also has two PhD, two 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. This year the Laboratory hosted a day visit from 24, year 11 Human Biology students from Kingsway College, organised by Jeff Keelan in conjunction with Louise Pollard and Cate Morris from Aspire UWA. The Aspire programme is aimed at working with schools, communities and educational organisations to raise aspirations amongst high school students in communities typically under-represented in higher education. The students were given the opportunity to see biomedical research at work, to see equipment in operation and find out about the pros and cons of a career in medical research. The visit was a great success and it is hoped that such visits will become a regular event in the future.
2010 was also the year that the laboratories went “robotic”. A QIAGEN Autopure LS was purchased and installed with funds generously donated by Channel 7 Telethon Trust and WIRF, to facilitate the extraction of DNA from the thousands of blood samples being collected by Associate Professor Craig Pennell’s team for the preterm genome project (amongst others). Lions International also continued their support for the Laboratories by donating a considerable sum which was used to fund the purchase of sterilising equipment, drug extraction apparatus and optical accessories for the laboratory’s fluorescent microscope. Professor Jeff Keelan Head
• • • Purchasing and acquisition of an automated DNA extraction and aliquotting platform. Visit by students from Kingsway College as part of the UWA Aspire Programme. Installation of a small autoclave unit to allow sterilisation of fluids and equipment for cell and tissue culture.
PhD student Ambika Singh demonstrates pipetting to students from Kingsway College.
Research Units
Research Units
PREM Bank (Perron Rotary Express Milk Bank)
On the 5th of July 2006, following the establishment of the PREM Bank (Australia’s first contemporary human milk bank), the KEMH Special Care Nursery began providing the option of Pasteurised Donor Human Milk (PDHM) to meet the nutritional needs of infants born less than 34 weeks corrected gestation age where a mother’s own breast milk was unavailable.
In 2008, 155 patients received PDHM. In 2009 that increased to 211 patients. The total volume dispensed rose from 443 litres to 698 litres. The volume of donor milk dispensed to the nursery has increased by 255 litres or 57%. To cope with this increased demand the PREM Bank has purchased and commissioned a new pasteuriser that has increased processing capacity from 3 litres per batch to 9 litres per batch. This was commissioned in July 2009.
Penrhos College Junior School visit to PREM Bank May 2010
PREM Bank staff have accepted a number of invitations to speak at national and international conferences in 2009. Dr Ben Hartmann also accepted an institutional consultancy from Medela AG to conduct a Human Milk Banking Symposium for health professionals (hospital and nursing directors and public health officials) in Beijing, China in April 2009. The PREM Bank has continued to be indebted to our very generous sponsors whose donations have allowed the establishment and expansion of our service. We acknowledge the generosity of the Rotary Clubs of Belmont, Thornlie, Ascot, Margaret River (WA) and Panaji Mid-Town (India), The Perron Charitable Trust, Channel 7 Telethon Trust, BHP Billiton, Alcoa, Medela AG, Hartleys Ltd, Penrhos Junior School and Clayton Utz (Staff and Partners). We must also thank the 258 mothers who have selflessly donated excess breastmilk to the PREM Bank since its establishment. Dr Ben Hartmann Manager (Scientist-in-Charge)
Dr Ben Hartmann
Since its establishment, the PREM Bank has been overwhelmed by the support of mothers wishing to donate. In 2006 there were 32 screened donors; in 2009 this had increased to 92 donors. The average volume of donation per donor in 2006 was 8.66L. This has now almost doubled to 16.11L. We have become more experienced in the selection of successful donors. This may account for the increase in average volume per donor. This increase in average donation decreases the cost of donor screening per volume of donated milk. Therefore, this increase in average donation volume over the 4 years of operation is indicative of an increasingly cost effective donor milk supply.
Research Reports
The Smile Study
Preventing preterm birth by treating periodontal disease in pregnancy
For many years, the possibility that periodontal (gum) disease may cause health problems elsewhere in the body has been of concern to health care practitioners. One of these potential problems has been preterm labour. It is well known that inflamed gum tissues release a host of chemicals into the woman’s blood stream, and some of these chemicals are capable of causing uterine contractions.
About 15% of pregnant women in our population have periodontal disease. Most are unaware of the problem, while others may experience bleeding from their gums or pain on biting. Studies conducted by ourselves and others have shown that women with periodontal disease are more likely to give birth prematurely. What has not been known, however, is whether the periodontal disease actually causes the preterm birth, or if some other factor is causing these women to be at risk of both periodontal disease and preterm birth. The purpose of this study was to identify pregnant women with periodontal disease and then treat a random half of them during midpregnancy to see if this treatment would improve the outcomes of the pregnancies. Such a study is called a randomised controlled trial, and provides the strongest evidence of whether a treatment is effective and safe. We named the project “The Smile Study”. Over nearly three years, 3737 pregnant women in metropolitan Perth were identified to be at increased risk of periodontal disease. Of these women, thorough dental examination revealed 1082 to meet the criteria for periodontal disease. These women were allocated at random to either receive full periodontal treatment in mid-pregnancy (n = 542) or to be offered such treatment commencing six weeks after the pregnancy was complete (n = 540; the control group). The study was conducted through the Foundation and involved King Edward Memorial Hospital, the Oral Health Centre of Western Australia, Osborne Park Hospital, Swan Districts Hospital, Armadale Hospital, Rockingham Hospital, and Joondalup Hospital. Re-examination of the women later in pregnancy showed that those women who had received treatment during the pregnancy had made substantial improvements in their oral health. The principal goal of this study was to find out if treatment of periodontal disease during pregnancy will prevent preterm birth, pre-eclampsia and fetal growth restriction. There were no differences in any of these end-points between the treatment and control groups, indicating that treatment of periodontal disease does not affect these key aspects of pregnancy. While this result was very disappointing, it also indicates that pregnant
women should feel free to have treatment of gum disease during pregnancy if they wish, as the treatment will not cause any unwanted side-effects for themselves or their unborn child. This study has now answered a major question in health care. The project was completed on-time and almost on-budget. Its success is testimony to the commitment of the thousands of women in Perth who participated and the expertise of the staff at the seven sites within our metropolitan area. This success has shown that the people of Perth are capable of conducting medical research of the highest possible standard, efficiently and with enthusiasm. We are very grateful for their combined efforts and thank every woman and every staff member for their generous commitment. For those who would like further details, the results have been published in Obstetrics and Gynecology, which is the highest ranked journal in this field (Newnham JP, Newnham IA, Ball CM, Wright M, Pennell CE, Swain J, Doherty DA. Treatment of periodontal disease during pregnancy. Obstetrics and Gynecology 2009; 114: 1239-48).
John Newnham
Dorota Doherty
Craig Pennell
Antonia Shand
Jonathon Swain
Ian Newnham
Chief Investigators
WIRF/UWA Winthrop Professor John Newnham MD FRANZCOG Associate Professor (Adj) Dorota Doherty BSc (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
6340 assessed for eligibility
2603 882 1721
excluded ineligible declined
3737 screened for periodontal disease 2650 no significant periodontal disease
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
1087 randomised
assigned to antenatal treatment withdrew consent before treatment (93.5%) attended at least one visit (88.3%) completed treatment
assigned to no treatment during pregnancy received no treatment during pregnancy
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
In 504 women treated: 95 (18.8%) one visit 280 (55.6%) two visits 105 (20.8%) three visits 18 (3.6%) four visits 6 (1.2%) five visits
Dental Assistant
Lorraine Howard
Major Sponsors
National Health and Medical Research Council of Australia Colgate-Palmolive Oral-B Channel 7 Telethon Trust
538 1 2
analysed lost to follow up pregnancies excluded due to miscarriages before treatment commenced
540 0 1
analysed lost to follow up triplet pregnancy excluded
Colleen Ball
Desiree Cavill
Renate McLaurin
Cherry Young
Michelle Wright
Esther Jansen
Belinda Orrock
Research Reports
The Raine Study
21 years...and still going strong
Overview of The Raine Study . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Raine Genetic Epidemiology Group . . . . . . . . . . . . . . . . . . . . . . . .22 Raine “Challenge Me” Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 The Fetal and Early Childhood Origins of the Polycystic Ovary Syndrome (PCOS) . . . . . . . . . . . . . . . . .24 The Fetal and Early Life Origins of Impaired Testicular Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
The Raine Study
From 1989 to 2010 - still going strong
Overview of Research
The Western Australian Pregnancy (Raine) Cohort Study is one of the largest and most successful longitudinal studies in the world. The Study commenced between 1989 and 1991 when 2900 pregnant women joined a study examining the effects of ultrasound imaging on birth outcomes in children born at King Edward Memorial Hospital. 2868 babies born during this period remained with the study, and progressed to form the Raine Study Cohort. Over the past 20 years, study participants have been assessed by a collaborative team of researchers. Follow up studies of the cohort were conducted at the Telethon Institute for Child Health Research at 1, 2, 3, 5, 8, 10, 14, 17 and 18 years of age with the 20 year follow-up now underway.
Over 1700 children have continued to participate throughout this period. Information has been collected for a wide number of research areas including physical health, fitness and motor competence, cardiovascular health, obesity and blood pressure, musculoskeletal conditions, asthma and allergy, nutrition and dietary patterns, mood and mental health, cognitive functioning and stress. Blood samples were collected at 17 years and permission was requested to extract DNA from the Raine participants. This will be used to examine the role of genes in contributing to health outcomes. With the progression of the cohort into young adulthood many of the Raine Study research projects have returned to King Edward Memorial Hospital and WIRF. Under the directorship of Assoc Professor Craig Pennell, the major areas of interest now concentrate primarily on the influence of antenatal and early childhood factors on the development of adult health conditions. Projects of the Reproductive Health Group, which includes Winthrop Professor John Newnham, Winthrop Professor Martha Hickey, Dr Deb Sloboda and Professor Roger Hart, are investigating the effect of prenatal androgen exposure on mental health in childhood and adolescence, and the fetal and early childhood origins of polycystic ovarian syndrome in females and fertility in young male adults. Research is being conducted into the influence of fetal and childhood development on stress and the function of the hypothalactic-pituitary-adrenal axis. The influence of genes on all areas of health and development, in association with fetal and early childhood factors, is one of the most exciting new areas of attention with a Raine genetic epidemiology group now established at King Edward Memorial Hospital. The Raine study has been responsible for over 114 published scientific papers, many of which have been highly cited. For example, at the recent international conference of the Society of the Developmental Origins of Health and Disease, over 12 papers from the Raine study were presented and were well received.
Raine Study participants
Scientific Director
Associate Professor Craig Pennell, MBBS PhD FRANZCOG
Study Manager
Ms Jenny Mountain (Telethon Institute for Child Health Research)
Chief Investigators
Winthrop Professor John Newnham MD FRANZCOG Winthrop Professor Fiona Stanley AC MBBS MSc MFPHM MD FFPHM FAFPHM MFCCH FRACP FRANZCOG Associate Professor Craig Pennell MBBS PhD FRANZCOG Winthrop Professor Lawrie Beilin AO MBBS MD FRCP FRACP Professor Roger Hart MD FRANZCOG MRCOG CREI Winthrop Professor Martha Hickey BA (Hons) MSc MBChB MRCOG FRANZCOG MD Associate Professor Leon Adams MBBS FRACP PhD Dr Wendy Oddy PhD MPH BAppSci Professor Leon Straker BAppSc MSc PhD Professor Beth Hands PhD Med BSocWk
Major Sponsors
Women and Infants Research Foundation Telethon Institute for Child Health Research The University of Western Australia The UWA Faculty of Medicine, Dentistry and Health Sciences Raine Medical Research Foundation, UWA National Health and Medical Research Council of Australia National Heart Foundation Rotary Health Research Canadian Institute of Health Research
Research Reports
Research Reports
Raine Genetic Epidemiology Group
Overview of Research
Chronic complex diseases are responsible for much of the burden of adverse health in Australia and other countries. It has been estimated that by 2020 the metabolic syndrome (obesity, coronary heart disease, hypertension, stroke, insulin resistance, type II diabetes and dyslipidemia) will account for half of the global burden of disease and represent a major public health issue in most countries in the world. Genetic Epidemiology is the study of the determinants of such complex human disease and, in particular, the role of genetics in these diseases.
The Raine Genetic Epidemiology group aims to identify genes that contribute to key developmental pathways in order to better understand the biology underlying the developmental origins of health and disease. Identification in early life and childhood of genetic signatures that may increase (or decrease) the risk of adult diseases including the metabolic syndrome, obesity, neurologic disorders and mental illness will provide opportunities to develop lifestyle or medical intervention strategies aimed at preventing these adverse outcomes. The Raine Genetic Epidemiology group has access to 2.5 million genetic variants in 1,500 of the Raine individuals which we are utilising to identify genetic pathways underlying characteristics that lead to these diseases. As part of a large international collaboration, the Raine study has identified genes for birth weight, gestational age, asthma, eczema, obesity, age of menarche, insulin resistance and glucose. It has been well described that low birth weight leads to increased risk of later disease. Although we can identify some of the environmental exposures that predispose individuals to these phenomena, the genetic components are yet to be determined. One of the genes that the Raine Genetic Epidemiology group has discovered is associated with both decreased birth weight and increased risk of diabetes in adulthood. However, birth weight may be an inappropriate measure of an individual’s growth potential, since different fetal growth rates may lead to the same birth weight. In collaboration with a cohort in Rotterdam, we used the unique detailed fetal growth measurements from the ultrasound imaging in the Raine Study to characterise this genetic association in more detail. We have also investigated an obesity gene that follows a similar pattern; this gene decreases an individual’s antenatal growth but increases their risk of obesity from childhood onwards. The Raine Study Genetic Epidemiology group, in collaboration with other large international cohorts, is at the forefront of the exciting new field of genetic research. Identification at birth of genetic signatures that enhance the risk of adult disease will provide opportunities to develop lifestyle or medical intervention strategies in future that may help prevent many of these adverse outcomes.
Chief Investigators
Associate Professor Craig Pennell MBBS PhD FRANZCOG Winthrop Professor Lyle Palmer PhD Winthrop Professor Lawrie Beilin AO MBBS MD FRCP FRACP Winthrop Professor John Newnham MD FRANZCOG Professor Stephen Lye PhD Professor George-Davey Smith PhD
Research Officers
Nicole Warrington BSc (Hons) Qi Wei Ang MSc
PhD Students
Julie Marsh MSc Sandra Louise BSc (Hons) Priyakumari Parmar MSc Scott White MD
Major Sponsors
National Health and Medical Research Council of Australia Canadian Institute of Health Research
Raine “Challenge Me” Study
Overview of Research
2010 saw the completion of recruitment for the Raine “Challenge Me” Study. The study is the largest assessment of stress-induced hypothalamic-pituitary-adrenal axis function ever conducted. We performed a total of 1,137 individual challenges of young adult participants in the Raine Study. The results of this study will be evaluated together with extensive data on intrauterine growth, early life events and development that were collected by the Raine Study during pregnancy, childhood and adolescence.
Highlights and Outcomes
A mother’s pregnancy environment and her child’s environment in the first few years of life are major contributors to the development of most of the chronic adult conditions which are emerging as important public health issues of our time. The Raine “Challenge Me” Study provides a unique opportunity to investigate how these early life events affect the developing hypothalamic-pituitary-adrenal axis (HPA) and how this may influence health in early adulthood. The HPA axis impacts on hormonal function, growth, behaviour and brain maturation throughout childhood and adolescence and sets patterns that persist into adulthood. The project was funded by the Canadian Institute of Health Research and is part of a larger project investigating the effects of genes and early growth which underlie the developmental origins of health and disease. “Challenge Me” was a psychological challenge administered individually to members of the Raine cohort when they reached 18 years of age. The exact nature of the challenge was only revealed to the participant once the study process had begun and was designed to provoke a mild stress response. The challenge utilised by our team is considered to be the gold standard for testing HPA responses to psychological stress. A number of blood and saliva samples were taken before and after the test so that hormonal changes during and after the stressful experience can be measured. Laboratory analysis is well underway and is expected to be completed by the end of 2010. This has been the first time that WIRF volunteers have been included in a research project. The involvement of these men and women was vital to the successful completion of the challenges and their participation is greatly appreciated. It is anticipated that the results of this study will provide important insights into some of the mechanisms with which early life development influences health throughout life.
L-R: John Sheppard, Raine Study participant Jessica Boyd, Anke van Eeklen, Karen Bosel, Krysia Zarzycki and Bill Robertson
Chief Investigators
Associate Professor Craig Pennell MBBS PhD FRANZCOG Dr Anke van Eekelen PhD Professor Stephen Lye PhD Winthrop Professor John Newnham MD FRANZCOG
Research Assistants
Karen Bosel BSc (Hons) Hilary Hii BSc (Hons) Blagica Penova-Veselinovic BSc (Hons) Krysia Zarzycki
WIRF Volunteers
Charlie Braekeveldt David Hyde Alan Robertson Bill Robertson John Robertson John Sheppard Alan Smith
Major Sponsor
Canadian Institute of Health Research
Research Reports
Research Reports
The Fetal and Early Childhood Origins of the Polycystic Ovary Syndrome (PCOS): A Prospective Cohort Study
Overview of Research
PCOS is the most common endocrine disorder in women. The origins of PCOS are unknown, but animal and small human studies suggest that PCOS may arise due to elevated prenatal androgen exposure. This hypothesis has not previously been tested in large prospective studies of normal pregnancy. This study aimed to test this hypothesis in the Raine Cohort using archived maternal and umbilical cord biological samples. Participation was demanding for these adolescents, requiring attendance on day 2-5 of menstrual cycle for ultrasound, blood tests and examination. Nevertheless, we recruited over 250 girls and successfully addressed all our study aims.
Winthrop Professor Martha Hickey BA (Hons) MSc MBChBMRCOG 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
Research Highlights
Our principal finding was that prenatal androgen exposure within the normal range did not predict PCOS in adolescence. Although a negative observation, this has received extensive interest from the endocrine community, since it rejects a widely-held hypothesis. Furthermore our study has been extended to look at other markers of reproductive function in adolescence and relate these to early life events. Perhaps our most significant finding is that an adolescent girl exposed to maternal smoking in-utero has a uterus 20% smaller and ovaries 10% smaller than her unexposed peers after correcting for other potential confounding variables.
Major Sponsors
National Health and Medical Research Council The University of Western Australia Department of Health Western Australia
We are grateful to the Raine Medical Research Foundation at The University of Western Australia and the Telethon Institute of Child Health Research for financial support and general support over the years. The collection of maternal data and samples was funded by the Women and Infants Research Foundation (WIRF) while the collection of adolescent data and samples was funded by NHMRC project grant number 403968 and by a University of Western Australia Ada Bartholomew Grant.
We are extremely grateful to all the families who took part in this study. We are grateful to Lee Ann Mahoney, Sarah Simpson and Helen Box for study recruitment and James Humphreys for database construction and maintenance and the KEMH ultrasound department for their assistance and understanding.
Dorota Doherty
Helen Atkinson
Lee Ann Mahoney
Sarah Simpson
Helen Box
Cherry Young
The Fetal and Early Life Origins of Impaired Testicular Function: A Prospective Cohort Study
Chief Investigators
Professor Roger Hart MRCOG FRANZCOG CREI Dr Stephen Junk BSc PhD Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD Dr Deb Sloboda BSc (Hons) MSc PhD Winthrop Professor Martha Hickey BA (Hons) MSc MB ChB MRCOG MD FRANZCOG
David Handelsman, ANZAC Institute Sydney Robert MacLachlan, Monash University Niels Skakkabaek, University of Copenahgen Robert Norman, University of Adelaide Professor Jan Dickinson, School of Women’s and Infants’ Health
We are extremely grateful to all the families who took part and continue to take part in this study, Raine Study coordinator Jenny Mountain, the KEMH ultrasound department and Fertility Specialists of Western Australia.
We are grateful to the Raine Medical Research Foundation at The University of Western Australia and the Telethon Institute of Child Health Research for financial support and general support over the years. The collection of maternal data and samples was funded by the Women and Infants Research Foundation (WIRF) while the collection of adolescent data and samples is funded by NHMRC project grant number 634457 and the testicular ultrasounds are funded by Merck Serono.
Overview of Research
The recruitment to this study began in April 2010 and by June 2010 we had recruited over 70 men from the Raine cohort. We aim to continue recruitment for 2 years and to correlate testicular function in adulthood; semen assessment, hormone measurement and testicular ultrasound, with early life events such as growth restriction, maternal smoking and childhood obesity. Furthermore by extending our collaboration with our Danish colleagues we aim to study the influence of maternal exposure to environmental disrupters in the early ‘90s on their son’s testicular function in adulthood.
Martha Hickey
Roger Hart
Deb Sloboda
Research Reports
Fetal Futures Program
The Fetal Futures Program has been developed with the principal aim to assess the long term outcomes of children who have problems in fetal life requiring treatments prior to delivery or soon after birth. With financial support from the Channel 7 Telethon Trust and the Women and Infants Research Foundation our research team has embarked upon a program to evaluate children of various ages who have experienced problems in fetal life. Although medical technology has the capacity to identify many fetal complications, there is at present a dearth of information about how the children develop later in life.
Our first project was to investigate the impact of anaemia and hypoxia upon the developing fetal heart by reviewing the cardiac function of children who received blood transfusions as a fetus The cardiac function of 25 children and adolescents who received intrauterine transfusions for severe fetal anaemia secondary to red cell isoimmunisation between 1992 and 2003 at King Edward Memorial Hospital has been assessed. Compared with age and gender-matched controls, the children who received fetal blood transfusions had a reduction in left ventricular mass and left atrial area. The resting ventricular function was maintained. We speculate this effect may be due to the impact of reduced oxygen carrying capacity upon fetal heart muscle cell proliferation and differentiation. The findings from this study will be presented at the International Society for Ultrasound in Obstetrics and Gynecology in Prague in October 2010 and the manuscript has been accepted for publication in Obstetrics and Gynecology Our second and current project is the assessment of the long term outcomes of children born with gastroschisis, a birth defect in the anterior abdominal wall. The prevalence of gastroschisis has increased over the past 30 years in all countries throughout the world, stimulating interest in the potential etiologies of this disorder. It has been speculated that the impact of human modification of the global environment may be responsible for modifications in human development, leading to an increase in disorders such as gastroschisis. 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 well underway and we have been successful in obtaining the services of Dr Susannah Fletcher as our lead research assistant for the project. Families of children born with gastroschisis have been very generous with their time and to date 40 children have been extensively assessed. We are hopeful that all recruited children will have been reviewed by December 2010. This project has stimulated several other research concepts, including assessment of parental coping mechanisms following the diagnosis of gastroschisis and potential etiologies of this congenital defect.
L-R (top row): Teresa Warner, Susannah Fletcher, Madhur Ravikumara. L-R (bottom row): Jan Dickinson and Emma Harris
Professor Jan Dickinson MD FRANZCOG Winthrop Professor John Newnham MD FRANZCOG Dr Luigi D’Orsogna MBBS FRACP Mrs Joan Sharpe M Cardiac Ultrasound AMS Mrs Teresa Warner RN RM DMU (Obstetrics & Gynaecology) Dr Corrado Minutillo FRACP Dr Madhur Ravikumara MBBS Dr Emma Harris MBBS Dr Susannah Fletcher PhD
Major Sponsors
Channel 7 Telethon Trust Women and Infants Research Foundation
Research Reports
Research Reports
The Preterm Genome Project
Utilising genetics for the prediction and prevention of preterm birth
Overview of Research
Preterm Birth is a serious and growing problem with over 12.5 million preterm births each year world-wide. Furthermore, a significant proportion of infant deaths can be directly attributed to preterm birth. The Preterm Genome Project (PGP) was initiated by the Preterm Birth International Collaborative (PREBIC) in 2007. PGP is a large international study investigating genes associated with preterm birth. Maternal and fetal DNA from 5000 cases of preterm birth and 5000 term deliveries is being collected world-wide. The project aims to identify new genes which will be targeted in future for research into the prevention of preterm birth.
The recent sequencing of the entire human genome and the rapid growth of sophisticated technology has enabled scientists to genotype large numbers of DNA samples faster and cheaper than ever before. Genetic research is now able to identify over 1 million genes that may be associated with many complex diseases including preterm birth. Our Western Australian research team is at the forefront of research into the genetic origins of preterm birth. Our current project aims to recruit 4000 women who deliver at King Edward Memorial Hospital, 75% of whom have had a preterm baby. We are collecting blood samples from each mother as well as cord blood samples from each baby to be genotyped. To date we have recruited over 800 women at KEMH. Thousands of samples from Western Australia and Denmark are currently being processed in the WIRF laboratories. The DNA is then genotyped at other facilities at UWA. Phase 2 of the PGP has now been completed. This study investigated genes associated with very early preterm labour and delivery. 1200 DNA samples from Australia and Denmark were successfully genotyped using the processes that we validated in Phase 1 of the project. Statistical analysis is currently being undertaken by 2 teams of genetic epidemiologists who are based in our department and in Oxford, UK. We are anticipating some exciting new results in the near future. We are now undertaking phase 3 of the study in which over 10,000 maternal and fetal DNA pairs is being collected over several study sites overseas and in Perth. Generous funding
Highlights and Outcomes
Evidence is rapidly emerging that human genetics is a significant contributor to preterm birth. Evidence from twin studies, population-wide genealogy databases and studies of genetics-linked risk factors all support the role that genetic predisposition may play. For example, mothers who were themselves born preterm have a dramatically increased likelihood of having preterm babies. The earlier a mother is born, the earlier her baby is likely to be. Early research has already identified a small number of genes that influence some women to be at higher risk of having a preterm baby. We now understand that no single gene is going to explain all preterm births; however, up to now, we haven’t had the technology to be able to investigate all genes simultaneously along with other factors already known to increase the risk of preterm birth.
Chief Investigators
Associate Professor Craig Pennell, MBBS PhD FRANZCOG Dr Jennifer Henderson PhD MPH Grad Dip (Adv Nursing) BSc
Research Midwives
Claire Haworth RN RM Catherine Wilson BSc RN RM Jan McFarlane RN RM
Research Assistants
Melanie Slater BSc (Hons) Blagica Penova-Veselinovic BSc (Hons) Catherine Coleman BSc (Hons)
International Collaborators
Director Michael Katz, MD, National March of Dimes, USA; Chairman Mario Merialdi MD, MPH, PhD. World Health Organization, Geneva; Executive Management Committee Ramkumar Menon, PhD, Nashville USA; George Davey Smith, PhD, Bristol UK; Eunhee Ha, PhD, Korea; Poul Thorsen, PhD, Denmark; Felipe Vadillo-Ortega, PhD, Instituto Nacional de Perinatologia, Mexico; Scott Williams, PhD, Vanderbilt University, USA; Siobhan Dolan, MD; Tim Frayling, PhD; Caroline Relton, PhD; and David Olson, PhD.
Major Sponsors
Melanie Slater, Research Assistant
from the World Health Organization, the March of Dimes and other funding agencies such as WIRF is supporting this ongoing research. In 2010 our research team was awarded a Channel 7 Telethon Trust grant of $600,000 which we have used to purchase new automated equipment to streamline DNA extraction. The new facility, based in the Women and Infants Health Research laboratories, is named the Telethon Western Australian Preterm Genome Project DNA Extraction Facility. We are now able to process large numbers of samples simultaneously, rapidly increasing our capacity to genotype DNA from study members. In addition to our own samples we have commenced processing for other groups on a cost-recovery basis. Through the establishment of a team of international experts and the work of research centres such as ours, we anticipate major advances into the genetic basis of preterm birth in the coming years. This research will be valuable in helping us to understand the causes of preterm birth and how we may be able to prevent this serious problem in future.
World Health Organization March of Dimes Birth Defects Foundation Preterm Birth International Collaborative Channel 7 Telethon Trust WIRF Capacity Building Grant
Research Reports
Research Reports
Substance Use in Pregnancy
Transmission of Buprenorphine in Breastmilk
Research Objectives and Outcomes
• • Assessment of the buprenorphine concentration in breast milk to assist mothers in their decision to breastfeed Preliminary data of daily dosing of 10mg buprenorphine indicate that infant exposure to the drug is low and unlikely to cause adverse effects.
Women on buprenorphine are recruited at approximately 36 weeks gestation. At approximately 2-3 weeks postpartum they are asked to provide a urine sample 4 hours after their buprenorphine dose, and milk samples from both breasts each time the infant is fed for 24 hours after the dose. The samples are stored in the home refrigerator and collected by the research midwife. During this visit she assesses the wellbeing of the infant and checks for any evidence of the neonatal abstinence syndrome. We have samples from six mothers and anticipate recruiting at least four more by the end of the year. To date only samples from two mothers have been analysed, both were on 10mg buprenorphine daily. The data suggest that infant exposure to buprenorphine via breastmilk was low and no adverse effects were observed or reported. Infant general health was good, and progress for age was within population expectations. No major problems were identified and no referrals were made. Preliminary data based on mothers daily dosing of 10mg buprenorphine indicate that infant exposure to the drug is low and unlikely to cause adverse effects. Further analyses will take into account the effect of a range of drug doses. Quantifying these will improve our understanding of the effect on the mother and newborn infants.
Overview of Progress
Buprenorphine is a drug used to treat people who are dependent on heroin or other opiates such as morphine. It is used as substitution therapy and an alternative to methadone which has been used by pregnant women for over 30 years. Buprenorphine offers advantages over methadone in terms of safety, relative ease of withdrawal, need for less frequent administration, and ease of transition to other treatments. Buprenorphine, marketed as Subutex or Suboxone, is not recommended for use in pregnancy or breastfeeding. However a growing number of pregnant women are choosing to use the drug, whether prescribed or obtained illegally. There is insufficient research on the use of buprenorphine by breastfeeding women to confidently state that it is as safe as methadone. We lack data on concentrations in breastmilk and are unable to provide evidence based information to opiate dependent mothers on buprenorphine to guide decisions on whether or not to breastfeed their infants.
ProfessorAnne Bartu PhD FRCNA Dr Dale Hamilton FRANZCOG Emeritus Professor Ken Ilett BPharm PhD Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD Renate McLaurin RN RM BHlth Sc S O’Halloran MSc Professor Peter Hackett LRCS AAIMLS
This study is designed to quantify the concentrations of buprenorphine in breastmilk of lactating mothers. The hypotheses to be tested are that (a) quantifying concentrations of buprenorphine will provide sufficient information and allow appropriate advice to be given to mothers, and (b) that sublingual buprenorphine at doses for opiate substitution will not significantly decrease milk production.
L-R: Dale Hamilton, Anne Bartu, Renate McLaurin
Role of Umbilical Cord Blood Gas and Lactate Analysis in Perinatal Care
Overview of Research
A baby’s blood gas measurement is widely recognised as the best method to identify asphyxia at birth. In 2002, umbilical cord gas screening was introduced for all births at King Edward Memorial Hospital for Women. A recent study of all births between 2003 and 2008, conducted by our group, has found marked improvements in outcomes over this time. Blood gas results have improved over this time; fewer babies have gases indicative of severe asphyxia and fewer babies are being admitted to the special care nurseries for signs of birth asphyxia. We have suggested that the immediate availability of objective measurements of newborn well-being may be partially responsible for these improvements.
Highlights and Outcomes
Until recently, universal cord gas screening had only been introduced to KEMH, which is a specialised obstetric hospital. It was not known whether introducing this technology to other less specialised hospitals would result in similar improvements. The current project is investigating the impact of introducing measurement of cord blood gas and lactate levels at delivery in a variety of metropolitan and regional centres in WA. Further, we are seeking to develop a greater understanding of how best to introduce such a program into other maternity units and to determine the costs and benefits of using this technology at all births. Universal umbilical cord blood gas and/or lactate analysis was introduced into one metropolitan and three regional maternity units approximately twelve months ago. We are monitoring the progress and results of this new practice and will be analysing these data annually for two years. Currently, the project is focussing on two areas of research. The first is comparing umbilical cord blood gas and/or lactate values with traditional measurements such as the Apgar score in order to predict early adverse neonatal outcomes. Secondly, we are evaluating four methods of collecting umbilical cord blood samples in order to determine the optimal manner to maintain the blood before the gases and lactate values can be processed. Work resulting from this project has been presented at a number of local, national, and international clinical and academic conferences in Australia, Canada and the United States of America over the last three years. Additionally publications associated with this project have been published in the Australian and New Zealand Journal of Obstetrics and Gynaecology as well as in the Thirteenth Perinatal Morbidity and Mortality Report of Health Department, Western Australia.
Chief Investigators
Mr Christopher White BMedSci (PhD Student) Associate Professor Craig Pennell MBBS (Hons) PhD FRANZCOG Dr Jennifer Henderson PhD MPH Grad Dip (Adv Nursing) BSc Associate Professor Paul McGurgan MB BCh BAO BA MRCOG MRCPI FRANZCOG Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD Winthrop Professor John Newnham MBBS MD FRANZCOG
Major Sponsors
Western Australian Department of Health The University of Western Australia
Research Reports
Research Reports
Placental Research
The Placental Research group is headed by Professor Jeff Keelan and consists of PhD students Ambika Singh and Irving Aye, Research Assistant Jessica Lewis, Honours students Rebecca Colvin and Vinith Menezes, and year IV medical students Tabitha Holmes and Emma Sorensen.
The Placental Research Group currently has four main areas of study: • • Placental inflammation and premature birth 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 Omega-3 fatty acids in pregnancy and on their placental inflammation and oxidative stress Nanoparticle drug delivery in pregnancy
L-R: Irving Aye, Jeff Keelan, Ambika Singh and Rebecca Colvin
Chief Investigators and Collaborators
WIRF/UWA School of Women’s and Infants’ Health Professor Jeffrey Keelan BSc (Hons) MSc PhD MRSNZ UWA School of Anatomy and Human Biology Winthrop Professor Arunasalam Dharmarajan BSc MSc MMedSci PhD Winthrop Professor Brendan Waddell BSc (Hons) PhD UWA School of Medicine and Pharmacology (Royal Perth Hospital Unit) Associate Professor Trevor Mori BSc (Hons) PhD Monash Institute of Pharmaceutical Sciences Dr Ben J Boyd BSc (Hons) PhD GDipDrugEval&PharmSc Liggins Institute, University of Auckland, New Zealand Professor Murray Mitchell DPhil DSc FAIC CChem FRSC FRSNZ
• •
The group has collaborative links with the Department of Anatomy and Human Biology, UWA, the School of Medicine and Pharmacology at Royal Perth Hospital, The Perinatal Research Centre at Melbourne’s Royal Women’s Hospital, University Hospital Zurich, Monash University’s Institute for Pharmaceutical Science, 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, and the NHMRC.
• • Publications on the use of anti-inflammatory drugs to block endotoxin-driven placental inflammation Novel discovery of anti-inflammatory lipids (protectins) in placentas from women on high fish-oil diets during pregnancy Publications on the mechanism of cholesterol transport across the placenta Young investigator prizes (National and International) won by PhD student Irving Aye
• •
Anaesthesia and Pain Relief
Overview of Research
The Department of Anaesthesia and Pain Medicine focuses on translational clinical research – that is the application of basic research findings to patient care. We are particularly interested in how to improve the experience of pregnant women having operations, how to deliver optimal pain relief to women during labour and after surgery, and the safety of medications among women who are establishing lactation and breastfeeding.
Research Highlights
This year we have completed studies on the use of acupressure wrist bands to prevent nausea or vomiting during labour (unfortunately not effective) and on the transfer of the painrelieving anti-inflammatory drug parecoxib into breast-milk (preliminary analysis suggests it is likely to be safe to use shortterm). We are also analysing the findings of a study of the effect of epidural pethidine, a method of pain relief used very frequently after caesarean delivery in Western Australia, on the initiation of lactation and on infant breastfeeding. To date the results appear reassuring. Our current studies are investigating the use of ultrasound imaging to assist epidural insertion; the optimum drug doses to treat falls in blood pressure after anaesthesia for caesarean section; and new combinations of pain relieving drugs after caesarean delivery. The most innovative research comes in two different studies. One is assessing the absorption and effectiveness of a new formulation of the strong pain-killer fentanyl, given in the form of a wafer that is placed under the tongue. This method is simple, fast-acting and appealing to patients. The pilot study will provide information for further early human studies, required for the process of regulatory approval. The second is part of a planned series of studies into the effects of a widely used drug, dexamethasone. This steroid drug is currently very popular as a means of preventing nausea and vomiting after surgery, but preliminary evidence from our collaborative group at Royal Perth Hospital suggests it may increase the risk of infections, so we are investigating its effect on a variety of important white blood cells that normally allow us to fight against infection.
L-R: Tracy Bingham, Nolan McDonnell, Emelyn Lee, David Law, Desiree Cavill
Chief Investigators
Winthrop Professor Michael Paech DM Clinical Senior Lecturer Dr Nolan McDonnell FANZCA Emeritus Professor Ken Ilett PhD Winthrop Professor Peter Hartmann PhD Associate Professor Stephen Lim MPharm Clinical Associate Professor Tomas Corcoran FANZCA Dr Yasir Al-Tamimi FRCA Dr Chris Mitchell FANZCA
Researchers/ Investigators
Desiree Cavill RM Tracy Bingham RM Dr Aneeta Sinha FRCA Dr David Law FANZCA Dr Timothy Pavy FANZCA Dr Emelyn Lee FANZCA
Major Sponsors
Pfizer Australia The Australian Society of Anaesthetists Women and Infants Research Foundation
Research Reports
Research Reports
Maternity Care for Rural and Remote Aboriginal Women in WA
Models of maternity care for Aboriginal women in non-metropolitan Western Australia: Evaluation of clinical outcomes and costs
Research Objective
• To evaluate pregnancy outcomes and resources used in the delivery of pregnancy care for two models of care: the traditional model of maternity care and the communitybased midwifery led model of care
Research Outcomes
• Midwifery led maternity care achieves better outcomes at a negligible additional cost compared to the traditional model of care Midwifery led care requires more funding for antenatal visits and improvement of pregnancy outcomes while the traditional care requires more funding to manage poor pregnancy outcomes
WA and in other states. However, the evidence that they improve the health of mothers and babies is insufficient and cannot be generalised. These service evaluations are almost always confined to one service, there are usually only a small number of women seen, there is no comparison with women who do not receive the service, and the components that make up the service are not clearly defined and may not be replicated. Our research overcomes practical and methodological limitations of how to evaluate new models of care in a generalised setting because the evaluation of models of care is performed on a large simulated cohort of hypothetical pregnancies. During the pregnancy simulations, antenatal complications and pregnancy outcomes are modelled according to the maternal characteristics and events during pregnancy. The resulting simulated cohort very closely reflects actual WA Aboriginal pregnancy outcomes. Pregnancy outcomes for both models of care are generated according to the hypothesised antenatal attendance, and the health outcomes and associated costs for both models of care are compared. These comparisons between the models include antenatal attendance, gestational age at first presentation for antenatal care, maternal and neonatal outcomes, and transfers to tertiary hospitals in metropolitan Perth. The two models under evaluation reflect the types of care that are available to non-metropolitan Aboriginal women: the traditional model of care women receive from a general practitioner or a hospital midwife service; and the communitybased midwifery lead care that offers a service responsive to Aboriginal women with links to the regional and tertiary

Overview of Research
Aboriginal mothers represent about 6.5% of all women who give birth in Western Australia each year, and 65% of these women live outside of metropolitan Perth. Generally, Aboriginal women experience poorer maternal outcomes compared to the non-Aboriginal women and their newly born babies often have poorer outcomes which may continue into childhood.
Many studies have demonstrated that more frequent attendance for antenatal visits achieves better pregnancy outcomes and new initiatives to improve maternity care are being investigated. Examples of good antenatal care for Aboriginal women exist in
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 FRCPCH Winthrop Professor John Newnham MD FRANZCOG Jeffrey Cannon BSc (Hons) BBus The Combined Universities Centre for Rural Health (CUCRH) Melissa Barrett RN RM MSci(Nursing) Associate Professor Ann Larson BA MA PhD Professor Isabelle Ellis RN RM MPHTM PhD Glenda Taylor Geraldton Regional Aboriginal Medical Service (GRAMS) Rhonda Bradley RN RM Cindy Porter BSci (Hons) MSci (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, Department of Health Western Australia
hospitals. The majority of non-metropolitan Aboriginal women can only access the traditional model of maternity care. Analysis of costs associated with the service delivery for both models shows that the midwifery led model of care offers a better health care at a very similar cost. The considerable expense incurred for the antenatal visits in the midwifery led model is preferable to the costs of hospital transfers and admissions to manage poor outcomes that occur more frequently in the traditional model of care. This project complements the WA Health reform process by providing an evaluation of the health outcomes and economic implications of the proposed models of maternity care. This research reflects a growing involvement in the health services research at the Women and Infants Research Foundation, and we hope to expand our health services research activities in obstetrics over the next few years.
Dorota Doherty
Janet Hornbuckle
Jeffrey Cannon
John Newnham
Karen Simmer
Glenda Taylor
Ann Larson
Melissa Barrett
Research Reports
Research Reports
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 are hypertension, renal disease, autoimmune disorders, thrombophilic states and multiple pregnancy. Women who have had a previous pregnancy complicated by high blood pressure or pre-eclampsia, may be at increased risk of these problems in future pregnancies and can be monitored accordingly. Women who have not yet had a baby, will not know if they have some of these risk factors and so we need to look at the information that is available. To this end, we are asking women and their partners about their cardiovascular health history in particular as well as that of their parents and siblings. 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 is being used to assess any relationships found. This study will interrogate the hypothesis that the risk of pre-eclampsia and associated pregnancy complications relate to family history of cardiovascular disease in the pregnant woman and her partner. We believe the medical history of the father of the baby may additionally inform the prediction of the incidence of preeclampsia in the mother.
Other Research
During the collection of delivery information for the family history study, we noticed that women with pre-eclampsia do not all present to hospital in the same way. Some start with mild symptoms that gradually get worse until delivery is considered necessary (Chronic Progressing), some have symptoms that go away and come back several times before delivery (Relapsing/Remitting) whilst others come in with very serious symptoms and need delivery urgently (Acute Fulminating). We designed a classification system based on these different presentations and tested it to see if the descriptions were accurate. The results were presented to an international meeting in Washington DC and were well received. 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.
School of Women’s and Infants’ Health, The University of Western Australia Clinical Associate Professor Barry NJ 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
Breastfeeding Research
Overview of Research
The aims of the Human Lactation Research Group led by Winthrop Professor Peter Hartmann are to provide the foundation for the development of evidence-based lactation practices through basic research. 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 Winthrop Professor Peter Hartmann in February 2010.
Milk ejection reflex is crucial for successful lactation but has been difficult to characterise in women due to the invasiveness and technical demands of previous methodologies. Dr Danielle Prime validated a non-invasive device (Showmilk, Medela AG) for its ability to measure the dynamics of milk flow and milk ejection during breast expression. Her findings indicated that each mother had a specific milk ejection pattern during the first year of lactation. Furthermore, the 'maximum milk flow rate' was able to predict the expected milk volume of a breast expression which could help tailor expression durations for mothers. Her work further advanced our understanding in the physiology of milk removal, and improved the traditional clinical guidelines in breast milk expression. Thermal pasteurisation of milk is currently used in milk banks around the world. Literature shows that while it reduces bacteria, it also reduces the bioactivity of human milk. Lukas Christen, an associate investigator, investigated the use of ultrasound to pasteurise human milk. His preliminary findings showed that ultrasound cavitation can reduce E. coli in human milk to log5 reduction standards. Furthermore, if the temperature remained below the critical level for protein denaturation, higher levels of bile salt stimulated lipase (an important enzyme for fat digestion) remained active in the treated milk samples. This work implicates ultrasound as a promising alternative pasteurisation method for human milk. Many people assume breastfeeding is natural for new mothers. However to attain breastfeeding skills it has been proven that vicarious learning is a very important method for the new mother. It is also recognised that education regarding all aspects of breastfeeding well before a woman has a child increases her desire and chances to succeed. In July, 2010, members of the lactation research group: Catherine Garbin, Holly McClellan, W/Prof Peter Hartmann, Dr Donna Geddes and Dr Ching Tat Lai, along with 6 breastfeeding mothers and their babies performed a live “breastfeeding show” at Mercedes College, Perth. It was the first day of 'Wellness Week' for the school. The group firstly spoke to the students about all aspects of breastfeeding and then with the mothers and babies, showcased examples of the evidence-base approach used by the team to undertake research breastfeeding. A total of over 900 college students from year 7-12 have now seen mothers and babies breastfeeding in real time and are now more aware and informed about breastfeeding. When the time comes for them to make decisions about feeding their own babies they now have some of their own experiences to draw on. Perhaps a seed has also been planted for some budding new breastfeeding scientists!
Research Highlights
• • • ShowMilk, a non-invasive device to determine milk ejection pattern and maximum milk flow rate of an individual mother. Ultrasound kills bacteria and retains more bioactivity of donor breast milk compare to thermal pasteurisation. Heightened awareness of the importance of breastfeeding in high school students.
Chief Investigator
Winthrop Professor Peter Hartmann BRurSc (Hons) PhD
Associate Investigators
Dr Donna Geddes PhD Dr Naomi Trengove PhD Dr Jacqueline Kent PhD Dr Ching Tat Lai PhD Dr James Lui PhD Dr Lynda Chadwick MBBS FRAP (Paed) Dr Jane Deacon MBBS Dr Marnie Rowan MBBS Catherine Garbin IBCLC Lukas Christen HF (Med Eng; Switzerland)
Research Students
Holly McClellean Gemma McLeod MSc APD Ibrahim Abdul MSc Sadaf Khan BSc Vanessa Sakalidis BSc (Hons) Claire Moliniari BSc (Hons) Elizabeth Thomas BSc Kristin Piper BSc Sharon Perrella MSc Ruth Abbott
Major Sponsors
Women and Infants Research Foundation Medela AG
Peter Hartmann
Donna Geddes
Naomi Trengove
Jacqueline Kent
Ching Tat Lai
Research Reports
Research Reports
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 treatments for newborn lung disorders with the goal of minimising lung injury and finding ways to optimise the long term respiratory health and wellbeing of premature babies.
In 2009-10, physiological studies were undertaken in the neonatal intensive care unit at KEMH, and within the research facilities at The University of Western Australia. The major infant studies involved measuring the physiological deadspace in ventilated preterm infants (Dr Schulzke and Dr Neumann) which will help us know how much air to give with each ventilator breath for babies of different sizes and levels of maturity. Dr Gabby Musk completed her studies on high-frequency jet ventilation and is in the final stages of preparing her thesis for submission. An especially exciting outcome of her work is the successful introduction of the jet ventilator to clinical practice. This was made possible at King Edward Memorial Hospital through the generous donation of two Life Pulse high-frequency jet ventilators via the Angel Breath campaign conducted by WIRF in partnership with the United Community Foundation and ABN Foundation and the community. The jet ventilator is already saving the lives of critically ill babies, and working to minimise the injury caused by the ventilation that is often required to keep them alive. We have continued our work investigating the vulnerability of the immature diaphragm to ventilator induced diaphragmatic dysfunction. Given that the diaphragm is the main muscle controlling our breathing, the work we are undertaking in this area will be incredibly important to help clinicians understand what ventilator strategies are least likely to damage the diaphragm, to give our babies the best chance of success when they are allowed to do their own breathing. A further example of work going from bench to bedside is the new Nebulised Surfactant study. Surfactant is a detergent like substance that makes it easier to breathe – but low levels of surfactant in the air cells is a prominent feature of many breathing diseases in newborn babies. Members of the group have been studying the delivery of surfactant by nebulisation – which would make it possible to treat babies with surfactant without intubating them first. This research is now entering clinical trials in the neonatal unit, following successful application for funding from the State Government. Through our association with Fisher & Paykel, we brought in researchers from the USA, Melbourne and Argentina in 2010, to investigate optimal ways to introduce air into the lung at birth in premature lungs. Analysis of this work is continuing and will be reported in 2011.
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
Dr Gabby Musk BSc BVMS Cert VA Dipl ECVAA MRCVS PhD Candidate Dr Rolland Neumann Neonatal Senior Registrar Dr Stefan Minocchieri Dr Yong Song Dr Clare Berry Ms Tina Lavin 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, The University of Western Australia Fisher & Paykel Healthcare National Health and Medical Research Council of Australia National Institutes for Health (USA) State Health Research Advisory Council, WA Department of Health
L-R: Stefan Minocchieri, Clare Berry, Jane Pillow, Yong Song, Tina Lavin
• • • • Complete the evaluation of physiological deadspace in ventilated preterm infants Award of a 2010-11 SHRAC Grant for Assessment of Nebulised Surfactant Awarded a NHMRC grant for respiratory follow-up of young children with bronchopulmonary dysplasia Successful bench to cotside translation of high-frequency jet ventilation to deliver “angel breaths” to newborn infants.
Impact of Caffeine and Maturation on Respiratory Control in Preterm Infants
Background and Objectives
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 mature in preterm infants and the impact that caffeine has upon this process.
Overview of Progress
Respiratory pattern measurements from 45 preterm infants have been obtained using specialised lung function equipment that measures airflow at the mouth during quiet sleep. Having now completed the data collection phase of the study, we are currently using Matlab scientific software to write program code which will permit the extraction of information about the variability occurring within the respiratory signals. In particular, we are interested in examining mathematical relationships within the tidal breathing fluctuations occurring over relatively short- (e.g. seconds) and long-time intervals (minutes). Identification of relationships within breathing fluctuations that are separated in time provides important insight into so-called memory within respiratory feedback control system. As a consequence, we can make some inference as to the effectiveness of respiratory control in preterm infants by learning something of the memory properties contained in each infant’s respiratory pattern. In previous work, we have demonstrated the presence of ‘memory’ properties within breathing patterns obtained from healthy term-born infants. The current study now aims to quantify these properties in preterm infants, and to determine whether the degree of prematurity, or the use of caffeine (i.e. a respiratory stimulant commonly used to prevent apnoea in preterm infants) has any identifiable impact on the breathing control system memory. In future, the possibility may exist for the acquisition of a short (~10 mins) breathing trace during normal sleep, which could provide us with a quantifiable indicator of the adequacy of respiratory control in preterm infants, potentially identifying those infants at most risk for abnormal breathing patterns, who may require closer or postdischarge monitoring. Furthermore, we may be able to identify those infants in whom caffeine should be continued for an extended period or after discharge.
Study Investigators
Dr David Baldwin FRACP PhD Dr Sven Schulzke MD Ms Ann McDonald RN Professor Jane Pillow FRACP BMedSc PhD Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH
Major Sponsor
Channel 7 Telethon Trust
David Baldwin
Sven Schulzke
Jane Pillow
Karen Simmer
Research Reports
Research Reports
Neonatal Nutrition – PANTS Trial
Probiotic supplementation for reducing all cause mortality and definite necrotising enterocolitis in preterm very low birth weight neonates - A randomised controlled pilot trial
image courtesy of Sunday Times
Overview of Research
This trial evaluates the efficacy of a probiotic (friendly bacteria in the gut that are beneficial to the host) supplement in colonising the gut (assessed by stool cultures) in premature babies born at gestation under 33 weeks. The other outcome of interest is tolerance to the supplement (abdominal distension, vomiting, and diarrhoea).
premature babies. If our trial results show that the probiotic supplement is well tolerated by premature babies, and the probiotic bacteria are effective in colonising the gut (as detected by stool specimen studies) without causing any significant adverse effects, the babies who are receiving the probiotic supplement stand to benefit in terms of reduced risk of death and severe disease like necrotising enterocolitis, and a decrease in the time taken to reach full milk feeds.
Research Highlights
Based on the current evidence and advice from other experts, we believe that it is now difficult to deny the benefits of routine probiotics supplementation to premature babies anymore. However non-availability of a well tested, tolerated, and safe product is the main hurdle towards providing probiotic therapy for premature babies in Australia. It is extremely important to confirm the identity of the probiotic bacteria and rule out potentially harmful contaminants and other ingredients in any commercial product before using it routinely in premature babies. It is equally important to confirm the ability of the specific probiotic bacteria in the product to colonise the gut of premature babies. Otherwise we will not know why the product did or did not work. Step I of our research project has already successfully identified a probiotic product that meets these basic criteria. The next step will be to test the ability of the probiotic bacteria in the supplement to colonise the gut in
Project Summary
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, and enhancing the protective barrier of the digestive tract. Human beings have been consuming these friendly bacteria for hundreds of years in the form of various food supplements, the commonest being Yogurt, and “Yakult” (containing the Shirota strain of the friendly bacteria lactobacillus casei). 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. Meta-analysis of the results of clinical
trials is an advanced statistical overview that provides the highest quality evidence to guide clinical practice. Our team at King Edward Memorial Hospital (KEMH) for Women, Perth, has recently conducted a conclusive meta analysis (overview) of 11 trials involving 2176 premature babies born under 33 weeks with birth weight under 1.5 kg. Our results showed that the risk of death and necrotising enterocolitis was reduced by 58% and 65% respectively in babies receiving probiotic supplement compared with control group babies. The time to achieve full milk feeds was also significantly less in babies receiving probiotic supplement. These remarkable, consistent, and reliable results indicate the tremendous potential of probiotic supplementation in saving premature babies from death and disease. Experts have commented that the overview by our team is an important step towards evidence-based use of probiotics in premature babies. Researchers in Japan have already been using probiotic supplementation as a routine for very (under 32 weeks) or extremely (under 28 weeks) premature babies since 1999. KEMH for Women is the sole tertiary neonatal referral centre for the State of Western Australia. Every year this extremely busy unit admits ~500 extremely premature babies who are at risk of death and diseases like necrotising enterocolitis. Given the current high quality evidence, the benefits of introducing probiotic supplementation in this high-risk population can not be over estimated. There are significant regulatory and technical difficulties in accessing a proven, safe, and effective probiotic product for routine use in premature babies. Our research involves two steps. Step I is laboratory testing of a potentially suitable probiotic product to confirm its contents (taxonomy confirmation) and safety (e.g. contaminants, unspecified components, osmotic load). Step II is a pilot clinical trial to evaluate the ability of the probiotic bacteria to colonise the gut. Having successfully completed Step I we are now proceeding towards the clinical trial (Step II: Estimated duration 6 months) to clear the way forward for the introduction of routine probiotic supplementation for premature babies in our nursery.
Chief Investigator
Associate Professor Sanjay Patole MD FRACP
Dr Girish Deshpande FRACP Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH Professor Patricia Conway: Professorial Fellow, Centre for Marine Bio-innovation, University of New South Wales Associate Professor (Adj) Dorota Doherty BSc (Hons) PhD
Channel 7 Telethon Trust
Sanjay Patole
Dorota Doherty
Karen Simmer
Research Reports
Research Reports
Neonatal Nutrition - The PeaNut Trial
Overview of Research
The goal of nutrition support for preterm infants is to achieve growth that is comparable to the healthy term infant. Human milk is the best and recommended source of nutrition for preterm infants but it has low protein and variable fat contents and extra protein and energy must be added to the milk to help infants meet their growth target.
Current practice is to routinely add these extra nutrients using an assumed milk composition but studies have shown that when milk if fortified in this way, preterm infants are lighter and fatter than term infants at the equivalent age. We hypothesised that individualising human milk on measured milk composition would result in better growth with lower amounts of body fat.
Using mid-infrared technology (MIRIS), we measured the composition of milk feeds and individualised fortification using commercial protein and energy supplements, according to the base-line composition of mothers’ milk. Standard anthropometric measurements and body composition measured with air displacement plethysmography were used to assess growth and percentages of fat mass near term age. As a first step, ultrasound was also investigated as an alternative method for assessing the influence of nutrition on early changes in the composition of weight gain. The study was completed in October 2009 and data analysis was finalised recently.
Gemma McLeod MSc APD (PhD Candidate) Associate Professor Jill Sherriff PhD Winthrop Professor Peter E Hartmann PhD Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH Liz Nathan BSc Dr Donna Geddes PhD
Major Sponsors
Australian Rotary Health Rotary Club of Thornlie The University of Western Australia Stan Perron Charitable Trust
Our study showed that on average, fortifying milk on measured rather than assumed milk composition did not result in better growth for preterm infants, though percentage of fat mass in both groups near term age was similar to healthy infants born at term. Given the variability of milk composition, it is possible that some infants with persistent poor growth would benefit from having their milk fortified on measured composition but as a routine, individualised nutrition is not beneficial. This was welcome news to the staff as the workload of individualised nutrition is considerable. Ultrasound proved to be a useful method in the early assessment of body composition in preterm infants and showed that patterns of increase in subcutaneous adipose tissue and muscle mass differed from fetal growth. Further investigation of this method for assessing preterm infant body composition is warranted.
Staff, mothers and infants of King Edward Memorial Hospital
Donna Geddes
Liz Nathan
Gemma McLeod
Peter Hartmann
Neonatal Nutrition - Intravenous Nutrition
Efficacy and safety of a new fish oil based lipid emulsion (SMOFlipid) compared with olive oil based lipid emulsion (Clinoleic) in preterm (<30 weeks) neonates – a randomised controlled trial Overview of Research
Fat emulsions are an essential part of parenteral nutrition (PN) combining a high energy load with an essential fatty acid (EFA) intake. Fat emulsions used in Australia for parenteral nutrition in preterm neonates have been based on either soybean oil or olive oil. Currently used olive oil based fat Clinoleic at KEMH has high ratio of omega-6 to omega-3 fatty acids (9:1) this may not be ideal for omega-3 LC-PUFA supply, which are important for neuro-development and vision of preterm neonates. On the other side newly available fish oil based fat SMOFlipid has appropriate ratio omega-6 to omega-3 fatty acids (2.5:1). SMOFlipid also contains olive oil (25%), coconut oil (30%) and soybean oil (30%). Better lipid clearance, reducing the risk of liver toxicity, reduced oxidative stress (due to presence of coconut oil MCT, olive oil and vitamin E), lower immune-activity (immue-neutral MCTs) and anti-inflammatory effects (due to fish oil, olive oil) are other potential advantages of SMOF.
Dr Girish Deshpande FRACP Dr Mangesh Deshmukh Winthrop Professor Karen Simmer MBBS PhD MRCP FRACP FRCPCH Professor Trevor Mori PhD Professor Kevin Croft PhD Judith Kristensen BPharm
Research Highlights
SMOF emulsion will lead to increased omega3-LC-PUFAs levels (RBC and Plasma), and at least similar oxidative stress in high-risk preterm neonates dependent on parenteral nutrition support.
Major Sponsors
Women and Infants Research Foundation
Study Population
Preterm neonates (<30 weeks gestation) admitted in the neonatal unit at KEMH (Sample size: total 30 patients)
The coordinating pharmacist not directly involved in patient care will randomise preterm neonates to prepared coded ready to use syringes of either Clinoleic or SMOFlipid intravenous lipid. Blood samples (1 mL) will be collected from baby before starting the study lipids and at the end of study (after 7 days) for plasma/RBC fatty acids, and stress levels of prematurity (Isoprostanes). Liver function tests, blood culture positive sepsis and growth will be monitored for safety.
30% of patients have been recruited already. The study is expected to be completed by end of 2010.
Research Reports
Research Reports
Australian Ovarian Cancer Study (AOCS)
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
Professor Tony McCartney Dr Yee Leung, Head of Department, Western Australian Gynaecologic Cancer Service, School for Women’s and Infants’ Health Professor Ian Hammond, Western Australian Gynaecologic Cancer Service, School of Women’s and Infants’ Health
Research Nurses
AOCS commenced in 2001 with the hypothesis “that different subtypes of ovarian cancer, at the histologic 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.”
Although recruitment ceased in 2006 when recruitment of the target cohort was greatly exceeded (Western Australia recruited 287 cases), there is ongoing prospective collection of clinical follow up information. Our research nurses have ensured high quality data is being collected. Less than 2% of the study population has been lost to follow up. The tissue bank of bio-specimens with clinical follow up data has resulted in numerous publications, with a further ten additions to the literature in the 2009-2010 year. Through NHMRC funding we are currently collecting ascitic fluid from ovarian cancer patients. This information will be used for future studies. For more information on AOCS, please visit www.aocstudy.org Women and Infants Research Foundation Cherry Young RN RM Colleen Ball RN RM BN Melanie Mosey RN RM
Yee Leung
Colleen Ball
Cherry Young
Melanie Mosey
Ovarian Cancer - Patterns of Care Survey
Research Objective
To collect basic socio-demographic and treatment (primary and adjuvant) information for all women diagnosed with ovarian cancer (including fallopian tube and primary peritoneal cancers) in Australia during a one year period to describe the patterns of patient management and to relate this to patient survival.
Identification of eligible women
All women diagnosed with invasive ovarian (including fallopian tube and primary peritoneal) cancer during 2005 will be identified through the state and territory-based cancer registries and/or hospital admitted patient databases according to standard procedures in each state. The year 2005 was selected as this is after the Clinical Practice Guidelines for ovarian cancer were introduced in 2004 but will also allow relatively timely evaluation of the relation between patterns of care and 5-year survival (in 2010-11). At a practical level, it is also a year when women were being recruited for the Australian Ovarian Cancer Study (AOCS) and detailed treatment information is already available through AOCS for these women. The cancer registries will be asked to extract information regarding full name, date of birth, date of diagnosis, address at diagnosis, ICD-10 and ICD-O codes and name and address of treating doctor and hospital. This information will be retained in a password-protected file within the cancer registry to allow future matching to death records.
Chief Investigator
Associate Professor Penelope Webb
Project Manager
Sue O'Brien
Site Investigators
Dr Stuart Salfinger and Dr Yee Leung, Western Australian Gynaecologic Cancer Service, School of Women’s and Infants’ Health
Research Nurse
Melanie Mosey RN RM
We will use descriptive statistics to summarise data regarding treatment of women (eg the proportion who see a gynaecologic-oncologist overall, and by state) - no individual level data will be reported. We will then conduct survival analysis to compare survival for women in different subgroups defined by clinicopathological (eg stage of disease) and treatment (eg did/did not see a gynaecologic oncologist) groups, adjusting for potentially confounding variables as required.
Research Reports
Research Reports
Laparoscopic Approach to Carcinoma of the Endometrium:
An International Multicentre Randomised Phase 3 Clinical Trial (LACE)
The primary hypothesis is that Total Laparoscopic Hysterectomy (TLH) is associated with equivalent disease-free 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). This study has the potential to change the preferred surgical management of women with endometrial cancer from TAH to TLH. The perceived benefits of TLH over TAH include significantly shorter hospitalisation and less biographical disruption, lower complication rates of wound infection, thromboembolic disease, blood loss and incisional hernias. Recruitment for this study was completed in June 2010 when the target of 758 patients was achieved. The first paper from this study has recently been published in Lancet Oncology. For more information on the LACE trials, please visit http://www.gyncan.org/trials/current-trials/view/lace-clinicaltrial/1
Principal Investigator
Professor Andreas Obermair, Queensland Centre for Gynaecological Cancer
Western Australian Chief Investigators
Dr Yee Leung, Head of Department, Western Australian Gynaecologic Cancer Service, School of Women’s and Infants’ Health Professor Tony McCartney
Western Australian Associate Investigators
Professor Ian Hammond, Western Australian Gynaecologic Cancer Service, School of Women’s and Infants’ Health Dr Stuart Salfinger, Western Australian Gynaecologic Cancer Service, School of Women’s and Infants’ Health
Research Nurses
Women and Infants Research Foundation Cherry Young RN RM Colleen Ball RN RM BN Melanie Mosey RN RM
Yee Leung
Colleen Ball
Cherry Young
Melanie Mosey
Evaluation of Preliminary Forensic Specimen Kits in Recent Sexual Assault
The Sexual Assault Resource Centre (SARC) was established in Perth in 1976, more than 30 years ago. It provides a 24 hour 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.
Following a recent sexual assault it is vital that a person has adequate access to not only medical care but also forensic care, if they so wish. Forensic evidence deteriorates rapidly with time and with activities such as eating, drinking, showering and passing urine. If forensic evidence cannot be collected early it may be lost completely. However, an immediate forensic examination is not always possible due to a lack of forensically trained medical staff, particularly in rural areas or due to concomitant medical and psychosocial requirements, which take priority over the forensic examination. 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 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.
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 Clinical Forensic Medicine Liz Nathan BSc
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
Research Objectives
This project aims to assess the usefulness of the Preliminary Forensic Specimen Kits in terms of rates of recovery of a reportable DNA profile. In order to determine the usefulness of the kits the DNA profile yield of the Preliminary Forensic Specimen Kits will be compared to that of the forensic specimens from the subsequent complete forensic examination. The Sex Assault Squad of the WA Police has received consistent and specific SARC training on the use of the Preliminary Forensic Specimen Kits and have now taken over the responsibility of training police officers about the use of 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.
L-R: Rae Cummins, Debbie Smith, Maureen Phillips
Research Reports
Our Heartfelt Thanks We are pleased to acknowledge and thank all our
donors who provided vital support to our research programs and fundraising activities in 2009/10.
Special thanks to our major donors: Telethon
Telethon has supported two key research projects:
Lions Clubs have actively supported WIRF for many years. Lions donations have been used to support research into preterm birth by providing the funding for us to equip our laboratory with up-to-date technology and the new equipment necessary to undertake our groundbreaking research. We certainly appreciate and value all the hard work that the Lions Clubs perform to raise this money, without which our laboratory would cease to remain competitive, up-to-date and productive.
Telethon Preterm Birth Genome Project
Preterm birth is a major health problem in Australia affecting one in every 12 babies born. Western Australia is involved in the Preterm Birth Genome Project, a global study lead by the World Health Organization. This study will unravel the genetic basis of why some babies are born early. Channel 7 Telethon Trust has supported this research by providing two robots, Helix and Squirt, to automate DNA extraction for this study on the more than 1200 babies that are born preterm each year at King Edward Memorial Hospital. Thanks to Telethon this study will move more rapidly to allow more effective prediction and prevention of preterm birth.
The Women and Infants Research Foundation was delighted to be the WA beneficiaries of the national Kmart Women’s Hospital Appeal. As part of Kmart's community program for 2010 the retailer ran a nationwide fundraising campaign focussing on women's health. All 184 stores collected spare change at their registers for two months (May/June 2010).
Probiotics and Neonates Study
Necrotising enterocolitis is a potentially life threatening condition involving gangrenous bowel in very premature babies. Deaths, necrotising enterocolitis, and feeding difficulties are a major problem in premature babies worldwide. Probiotics are live beneficial microorganisms present naturally in the intestine. These friendly microorganisms can reduce the risk of necrotising enterocolitis by 65% and of death by 58% in premature babies. With Telethon support the team at King Edward Memorial Hospital has identified a probiotic suitable for routine use in premature babies. Completion of its clinical trial will clear the way forward for routine use of probiotics in premature babies a significant mile stone for neonatology in the western world.
Cash & Carry
Cash and Carry invited the Women and Infants Research Foundation to become recipients of their My Community Program. My Community rewards customers with charity tokens for every $100 spent. Each month, the tokens are converted to cash and donated to WIRF.
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 2009/10 financial year.
L-R: Professor John Newnham (WIRF), Jeff Newman – Channel 7 Telethon Trust, Tina Williams (WIRF) and Richard Court – Channel 7 Telethon Trust
Thank You
Thank You
Our Heartfelt Thanks to Our Supporters
United Community staff and Professor Jane Pillow
Angel Breaths Campaign
The ‘Angel Breaths’ Campaign was launched in July 2009 with our partners; United Community Foundation. The campaign was created to raise enough money to purchase a Jet Ventilator for the special care baby unit at King Edward Memorial Hospital and support research into premature birth. United Community (formerly United Credit Union) kicked off the launch by making a donation of $30K and promoting the campaign in their 14 WA branches. With the help of several major donors and the general public (with special thanks to the following families - Moullin, Linquist, Feasey, Musbah and many more organisations and individuals) the first Jet Ventilator was purchased in December 2009. The ABN Foundation joined the campaign and donated the second Jet Ventilator in March 2010. The WIRF Angel Breaths Campaign raised over $100K last year. Now the challenge continues. We need to fundraise for new equipment to help premmie babies at King Edward and to support research in preventing and reducing the dangers of preterm birth.
Professor Jane Pillow with Anita, Jamie and Hugo Moullin
Our Heartfelt Thanks to Our Donors
Our appreciation and gratitude also goes to our donors listed below and to those who wish to remain anonymous:
303 Perth ABN Foundation Alerdyce, Sue Allgrove, Catherine Argonaut Ltd Atkins, Michael Atom Supply Balfour, Yatiha Barker, Lynda Baxter Healthcare Bayer Healthcare Bennett, Peter Blackwell, Narelle Bower, Caroline Braid, Bob Bridge, Sharon Brown, Matt Brown, Ross Bunnings Warehouse Burnaby, Valerie Burns, Andrea Burns, Mark Cameron, Rosa Campbell, C J Carrington-Jones, Ann Cash and Carry Channel 7 Telethon Trust Cheang, Waipheng Cimetta, Barbara Dale, Bryan David, Peter Dawson, Craig and Julie Day, Darrren Delahunty, Ebonie Diamond, Dean Draper, Nick East Victoria Park Pharmacy Egerton-Warburton, Grey Ellet, Paul Farrington, Kim Feasey, Paul and Joanne Fernandes-Dodsley, Neal and Denise French, Noel Garton, Janet Georgiades, John Good, Alan Gotte, Jason and Vicky Grand Cinemas Grasmere Nominees Pty Ltd Guerrero, Ana Hammer, Amy Harris, Faamama Hartleys Limited Hartmann, Peter Harvey World Travel Booragoon Hawkins, Melanie Hitchcock, Paula Hobson, Jo Horvath, Victor Hutchinson, Maureen Isherwood, Karen Kaitse, Kelley Karczub, Anne Kearvel, John KEMH Postgraduate Medical Education KMART KPMG Lamb, Nigel Lions Club of Floreat Lions District 201W1 Littlepage, Vanessa Lucas, Anna Maroini, Fred Marriot, Dave Maslin, Jack Maurice Meade McCann, Jemma McGowan, Jo Morcombe, Nicole Moullin, Jamie and Anita Murdoch, Marjorie Newnham, John NIC Christmas Fund Nurses and Midwives Board O’Neill, David Paech, Michael Papalia, Maria Passmore, RI and KF Pay, Leo Payne, Anne Penrhos College Pillow, Jane Polglase, Graeme Rowley, Jann Salvemini, Conlie Schofield, Lynette Scholz, Colin Seddon, Lewis Shilcock, Roger Stedman, Dave Strudwick, Susan Sutherland, Katherine The Alternative Centre The Great Escape Toy, Helen Turner, Ron United Community Foundation Van der Struyf, Dirk and Stephanie Vouteva, Treslava Wadhwa, Roma Warrilow, Pamela Westell, Jacqui White, Darren Williams, Lyn Williams, Raelene Williams, Tina Wlazlowski, Cathy Wylie, Jerry
We are extremely grateful to everyone who has assisted the Foundation financially and in kind.
Thank You
Thank You
Our Heartfelt Thanks to Our Volunteers
At the heart of the Foundation are our seventy treasured volunteers. WIRF operates two businesses at King Edward Memorial Hospital; First Photo – Professional Baby Photography Service and the WIRF Café/Gift Shop. All profits are used to support the Foundation’s research and to purchase new equipment in our laboratories and within the hospital. They all play a vital role by assisting in research studies, serving and preparing snacks in the café/gift shop, and helping in our photography office.
We would also like to thank our volunteers who work tirelessly at home to produce beautiful knitted and sewn items for the gift shop. Our Volunteers’ dedication and commitment is outstanding and we are very grateful for their contributions. We would like to thank all our volunteers listed below by date of joining Friends of Women and Infants Research Foundation:
“I wanted to do give something back to my community. I do this by helping out in the Foundation’s office for a few hours each week.” Wai Ka, WIRF Office Volunteer
Jill Berecry Raie Bradshaw Janice Braekevelt Kate Campbell 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
Gillian Ball Elizabeth Hyde Rema Starina Joy Tillett
Christine Bailey Muriel Boyd Waipeng Cheang Athene Mathison Fay Miriklis Olga Mirmikidis Emma Reynalds Vanessa Ryan Aileen Swarbrick
Ann Carrington-Jones Patricia McInnes
Loretta Connery Janet Chang Tina Relf Pam Sulc
Karen Fresson Suan Williams Wai Ka Wong
Meredith Cziesche Elaine Horton Beattie Ramel
Beverley Boyd Leah McVeigh
Diana Fletcher June Fox Zoe Hewitt-Dutton Elizabeth Luzar Robin Simon Judith Williams
Maggie Cooper Suzanne Draper Pam Imms Nina Leahy Kay Lodge Yvonne Neurauter Helen Roatch Helen Robertson
Fay Carmody Carol Darby Mary Muscroft Julie Nolan
“Volunteering at WIRF allows me to 'give back' in a small way for the wonderful services I received from KEMH during my pregnancy, delivery and after the birth of my daughter, Rosie. I volunteer in the gift shop one morning each week.” Vanessa, Gift Shop Volunteer
Sylvia Webster
Research Support
External Research Grants affiliated with the Women and Infants Research Foundation
The Women and 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 and Medical Research Council. Following is a list of competitive grants supported during the current financial year ending 30 June 2010:
National Health and Medical Research Council (NHMRC) (AUSTRALIA)
National Institutes for Health (USA) - Cincinnati Childrens Hospital Medical Centre
• • MECHANISMS OF FETAL SYSTEMIC INFLAMMATORY RESPONSE SYNDROME INDUCED BY CHORIOAMNIONITIS. Investigators: S Kallapur, J Newnham, A Jobe (2009-2013 $452,505) NEW MEDIATORS OF CLINICAL LUNG MATURATION. Investigators: A Jobe, M Ikegami, J Newnham $ 67,525 $ 86,701
National Institutes for Health (USA)
• • NEONATAL RESUSCITATION AND PRETERM LUNG INJURY. Principal Investigators: A Jobe, M Ikegami, J Pillow. (2005-2009 USD 283,829) CONTROL OF MENSTRUAL BLEEDING DISTURBANCES IN WOMEN. Principal Investigators: I Fraser, L Salamonsen, J Findlay, M Hickey. (2003-2007 $287,409) $ 46,021 $ 3,200
Raine Medical Research Foundation
• THE ABC’S OF PLACENTAL CELL DEATH AND DIFFERENTIATION. Principal Investigator: J Keelan (2009-2010 $100,000) $ 35,296
National Heart Foundation of Australia
Canadian Institutes of Health Research (CIHR)
The World Health Organization (WHO)
• PRE-TERM BIRTH GENOME PROJECT. Investigators: C Pennell, S.Lye, A Bocking. (2008-2010 $766,870) $ 272,738
Research Support
Research Support
Research Support continued
The University of Alberta
• PRE-TERM BIRTH GENOME PROJECT. Investigators: C Pennell, S.Lye, A Bocking. (2008-2010 $766,870) $ 100,543
The University of Sydney
• CHILDHOOD DETERMINANTS OF RISKY SEXUAL BEHAVIOUR IN ADOLESCENCE: A PROSPECTIVE COHORT STUDY. Investigators: R Skinner, M Hickey, E Mattes, D Doherty, S Rosenthal, A Smith, S Cooper. (2010-2012 $154,000) $46,480
Sylvia and Charles Viertel Charitable Foundation
$ 198,807
The Danish Council for Strategic Research
Department of Health - WA
• EVALUATION OF THE INTRODUCTION OF UNIVERSAL CORD BLOOD GAS SCREENING TO W.A. MATERNITY UNITS. Investigators: C Pennell, C White, P McGurghan, J Henderson, D Doherty, J Newnham (2008–2009 $93,000) $ 42,000
Queensland Centre for Gynaecological Cancer
Peter MacCallum Cancer Institute
• AUSTRALIAN OVARIAN CANCER STUDY (AOCS). Investigators: Y Leung, D Bowtell, A Green, A de Fazio (2001–2011 $84,000) $ 24,225
Commercial Research Support
• • BAYER SCHERING PHARMA AG – Impact of Novel Progestins on the Endometrium. Investigator: H Atkinson (2009–2010) MERCK SERONO AUSTRALIA – Testicular Ultrasound. Investigator: R Hart (2010 – 2011) $ 163,836 $ 9,000
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:
$ 1,302,373
Total Research Support for 2009 / 2010
$ 2,962,591
Financial Statements
Women and Infants Research Foundation Inc. Income Statement for the year ended 30 June 2010
2010 $ 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 3,222,314 -154,342 -55,341 -1,833,760 -342,685 -1,068,503 -8,187 -240,504 -240,504 2009 $ 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
A full copy of the Foundation’s audited general purpose financial report for the year ended 30 June 2010 is available at www.wirf.com.au
Balance Sheet as at 30 June 2010
2010 $ 2009 $ 2,154,616 315,150 37,937 34,233 2,541,936
Cash and Cash Equivalents Trade and Other Receivables Inventories Other Current Assets Total Current Assets 935,703 196,623 23,201 22,204 1,177,731
Financial Assets Property, Plant and Equipment Total Non-Current Assets Total Assets 4,028,943 923,752 4,952,695 6,130,426 2,814,050 599,136 3,413,186 5,955,122
Trade and Other Payables Short Term Provisions Total Current Liabilities 1,817,153 108,755 1,925,908 1,639,973 86,833 1,726,806
Long Term Provisions Total Non-Current Liabilities Total Liabilities Net Assets 29,940 29,940 1,955,848 4,174,578 29,624 29,624 1,756,430 4,198,692
Retained Earnings Reserves Total Equity 3,298,667 875,911 4,174,578 3,585,803 612,889 4,198,692
Financial Statements
P ublications
Publications in peer review scientific journals (July 2009 - December 2009)
Abou-Setta, A.M., D'Angelo, A., Sallam, H.N., Hart, R.J. and Al-Inany, H.G. Post-embryo transfer interventions for in vitro fertilization and intracytoplasmic sperm injection patients (Review), The Cochrane Database of Systematic Reviews, DOI: 10.1002/14651858:4 (2009) Anderson, P.M., Opfer, E.K., Busch, J.M. and Magann, E.F. An Early Abdominal Wall Ectopic Pregnancy Successfully Treated with Ultrasound Guided Intralesional Methotrexate: A Case Report, Obstetrics and Gynecology International, doi:10.1155/2009/247452: (2009) Baczyk, D., Drewlo, S., Proctor, L., Dunk, C., Lye, S. and Kingdom, J. Glial cell missing-1 transcription factor is required for the differentiation of the human trophoblast, Cell Death and Differentiation, 16: pp 719-727 (2009) Braun, T., Li, S., Sloboda, D.M., Li, W., Audette, M.C., Moss, T.J., Matthews, S.G., Polglase, G.R., Nitsos, I., Newnham, J.P. and Challis, J. Effects of Maternal Dexamethasone Treatment in Early Pregnancy on Pituitary-Adrenal Axis in Fetal Sheep, Endocrinology, 150:12, pp 5466-5477 (2009) Brooks, J. Emotional health during pregnancy and early parenthood - An information booklet for parents of multiple birth children, Australia (2009) Brooks, J., Nathan, E., Speelman, C., Swalm, D., Jacques, A. and Doherty, D.A. Tailoring screening protocols for perinatal depression: prevalence of high risk across obstetrics services, Archives of Women's Mental Health, 12: pp 105-112 (2009) Brown, J.A., Morrison, J.C., Magann, E.F. and Cefalo, R.C. Fetal extrasystole may predict poor natal outcome, Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: pp 404-406 (2009) Calvert, N., Damiani, S., Sunario, J., Bower, C. and Dickinson, J.E. The outcomes of pregnancies following a prenatal diagnosis of fetal exomphalos in Western Australia, Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: pp 371-375 (2009) Carmody, D.F., Jacques, A., Denz-Penhey, H., Puddey, I.B. and Newnham, J.P. Perceptions by medical students of their educational environment for obstetrics and gynaecology in metropolitan and rural teaching sites, Medical Teacher, 31:12, pp e596-e602 (2009) Cavanagh, P.G., Dunk, C., Pampillo, M., Szereszewski, J.M., Taylor, J.E., Kahiri, C., Han, V., Lye, S., Bhattacharya, M. and Babwah, A.V. Gonadotropin-releasing hormone-regulated chemokine expression in human placentation, American Journal Physiology: Cell Physiology, 297: pp C17-C27 (2009) Challis, J., Lockwood, C.J., Myatt, L., Norman, J.E., Strauss, J.F. and Petraglia, F. Inflammation and Pregnancy, Reproductive Sciences, 16:2, pp 206-215 (2009) Challis, J. and Connor, K. Glucocorticoids, 11 beta Hydroxysteroid Dehydrogenase: Mother, Fetus, or Both?, Endocrinology, 150:3, pp 10731074 (2009) Chin, J., Konje, J.C. and Hickey, M. Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen, Cochrane Database of Systematic Review, DOI:10.1002/14651858: (2009) Clarke, J., Showell, M.G., Hart, R.J., Agarwal, A. and Gupta, S. Antioxidants for female subfertility, Cochrane Database of Systematic Reviews, DOI: 10.1002/14651858.CD007807:2 (2009) Connor, K.L., Challis, J., van Zijl, P., Rumball, C.W., Alix, S., Jaquiery, A.L., Oliver, M.H., Harding, J.E. and Bloomfield, F.H. Do Alterations in Placental 11 beta Hydroxysteroid Dehydrogenase (11 beta HSD) Activities Explain Differences in Fetal Hypothalamic-Pituitary-Adrenal (HPA) Function Following Periconceptional Undernutrition or Twinning in Sheep?, Reproductive Sciences, 16:12, pp 1201-1212 (2009) Connor, K.L., Bloomfield, F.H., Oliver, M.H., Harding, J.E. and Challis, J. Effect of Periconceptional Undernutrition in Sheep on Late Gestation Expression of mRNA and Protein From Genes Involved in Fetal Adrenal Steroidogenesis and Placental Prostaglandin Production, Reproductive Sciences, 16:6, pp 573-583 (2009) Crossley, K.J., Allison, B.J., Morley, C.J., Davis, P.G. and Polglase, G.R. Dynamic changes in the direction of blood flow through the ductus arteriosus at birth, Journal of Physiology - London, 587: pp - (2009) Crossley, K.J., Morley, C.J., Allison, B.J., Davis, P.G., Wallace, M.J., Zahra, V.A., Hooper, S.B. and Polglase, G.R. Antenatal Corticosteroids Increase Fetal, But Not Postnatal, Pulmonary Blood Flow in Sheep, Pediatric Research, 66: pp 283-288 (2009) Czank, C., Simmer, K.N. and Hartmann, P.E. A method for standardizing the fat content of human milk for use in the neonatal intensive care unit, International Breastfeeding Journal, doi:10.1186/17464358-4-4: (2009) Czank, C., Prime, D.K., Hartmann, B., Simmer, K.N. and Hartmann, P.E. Retention of the Immunological Proteins of Pasteurized Human Milk in Relation to Pasteurizer Design and Practice, Pediatric Research, 66:4, pp 374-379 (2009) Deshpande, G. and Gill, A. Cardiac arrest following naloxone in an extremely preterm neonate, European Journal of Pediatrics, 168: pp 115117 (2009) Deshpande, G.C., Simmer, K.N., Mori, T.A. and Croft, K.D. Parenteral lipid emulsions based on olive oil compared with soybean oil in preterm (<28 weeks' gestation) neonates: A randomised controlled trial, Journal of Pediatric Gastroenterology and Nutrition, 49: pp 619-625 (2009) Dickinson, J.E. and Doherty, D.A. Optimization of third-stage management after second-trimester medical pregnancy termination, American Journal of Obstetrics and Gynecology, 201: pp 303.e1-303.e7 (2009) Dickinson, J.E., Harcourt, E. and Murch, A. The selective use of rapid aneuploidy screening in prenatal diagnosis, Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: pp 28-33 (2009) Dickinson, J.E. and Doherty, D.A. Factors influencing the duration of pregnancy termination with vaginal misoprostol for fetal abnormality, Prenatal Diagnosis, 29: pp 520-524 (2009) Dong, X., Yu, C., Shynlova, O., Challis, J., Rennie, P.S. and Lye, S. p54nrb Is a Transcriptional Corepressor of the Progesterone Receptor that Modulates Transcription of the Labor-Associated Gene, Connexin 43 (Gja1), Molecular Endocrinology, 23:8, pp 1147-1160 (2009) Ennen, C.S., Bofill, J.A., Magann, E.F., Bass, J.D., Chauhan, S.P. and Morrison, J.C. Risk Factors for Cesarean Delivery in Preterm, Term and Post-Term Patients Undergoing Induction of Labor with an Unfavorable Cervix, Gynecologic and Obstetric Investigation, 67: pp 113-117 (2009) Flenady, V., Froen, F.J., Pinar, H., Torabi, R., Saastad, E., Guyon, G., Russell, L., Charles, A.K., Harrison, C., Chauke, L., Pattinson, R., Koshy, R., Bahrin, S., Gardener, G., Day, K., Petersson, K., Gordon, A. and Gilshenan, K. An evaluation of classification systems for stillbirth., BMC Pregnancy and Childbirth, doi: 10.1186/1471-2393-9-24.: (2009)
Furness, S., Roberts, H., Marjoribanks, J., Lethaby, A., Hickey, M. and Farquhar, C. (Review)Hormone therapy in postmenopausal women and risk of endometrial hyperplasia, p DOI: 10.1002/14651858, United Kingdom (2009) Garry, R., Hart, R.J., Karthigasu, K.A. and Burke, C. A re-appraisal of the morphological changes within the endometrium during menstruation: a hysteroscopic, histological and scanning electron microscopic study, Human Reproduction, 24:6, pp 1393-1401 (2009) Gilles, M.T., French, M.A. and Dickinson, J.E. Variable uptake of recommended interventions to reduce mother-to-child transmission of HIV in Australia, 1982-2005, Medical Journal of Australia, 190:4, p 220 (2009) Hagan, R., Rice, N. and Jones, A.M. Health and Retirement in Europe, International Journal of Environmental Research and Public Health, 6: pp 2676-2695 (2009) Hart, R.J., Sloboda, D.M., Doherty, D.A., Norman, R.J., Atkinson, H.C., Newnham, J.P., Dickinson, J.E. and Hickey, M. Prenatal Determinants of Uterine Volume and Ovarian Reserve in Adolescence, Journal of Clinical Endocrinology and Metabolism, 94:12, pp 4931-4937 (2009) Henderson, J.J., Newnham, J.P., Simmer, K. and Hartmann, P.E. Effects of antenatal corticosteroids on urinary markers of the initiation of lactation in pregnant women, Breastfeeding Medicine, 4:4, pp 201-206 (2009) Hickey, M. and Agarwal, S. Bleeding with menopausal hormone therapy, Best Practice & Research Clinical Ostetrics and Gynaecology, 23: pp 141-149 (2009) Hickey, M., Peate, M., Saunders, C.M. and Friedlander, M. Breast cancer in young women and its impact on reproductive function, Human Reproduction Update, 15:3, pp 323-339 (2009)
Jaffer, S., Shynlova, O. and Lye, S. Mammalian Target of Rapamycin Is Activated in Association with Myometrial Proliferation during Pregnancy, Endocrinology, 150: pp 4672-4680 (2009) Jobe, A., Nitsos, I., Pillow, J.J., Polglase, G.R., Kallapur, S.G. and Newnham, J.P. Betamethasone dose and formulation for induced lung maturation in fetal sheep, American Journal of Obstetrics and Gynecology, 201:6, pp 611.e1-611.e7 (2009) Kallapur, S.G., Moss, T.J., Auten, R.L., Nitsos, I., Pillow, J.J., Kramer, B.W., Maeda, D.Y., Newnham, J.P., Ikegami, M. and Jobe, A. IL-8 signaling does not mediate intra-amniotic LPS-induced inflammation and maturation in preterm fetal lamb lung, American Journal of Physiology: Lung Cellular and Molecular Physiology, 297: pp L512-L519 (2009) Keelan, J.A., Khan, S., Yosaatmadja, F. and Mitchell, M.D. Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-Kappa B Inhibitor, The Journal of Immunology, 183: pp 5270-5278 (2009) Knight, B.S., Sunn, N., Pennell, C.E., Adamson, S.L. and Lye, S. Developmental regulation of cardiovascular function is dependent on both genotype and environment, American Journal of Physiology: Heart and Circulatory Physiology, 297: pp H2234-H2241 (2009) Kozyrskyj, A.L., Kendall, G.E., Zubrick, S.R., Newnham, J.P. and Sly, P.D. Frequent nocturnal awakening in early life is associated with nonatopic asthma in children, European Respiratory Journal, 34: pp 1288-1295 (2009) Lethaby, A., Hickey, M., Garry, R. and Penninx, J. (Review)Endometrial resection/ablation techniques for heavy menstrual bleeding, p DOI: 10.1002/14651858, United Kingdom (2009) Li, S., Moss, T.J., Nitsos, I., Challis, J., Newnham, J.P. and Sloboda, D.M. Maternal Administration of Synthetic Glucocorticoids Significantly Alters Fetal Sheep Hypothalamic Gene Expression in a Site Specific Manner, Society for Gynecologic Investigation, United States, Sage, 16: p 357A (2009) Lockwood, C.J., Krikun, G., Hickey, M., Huang, S.J. and Schatz, F. Decidualized Human Endometrial Stromal Cells Mediate Hemostasis, Angiogenesis, and Abnormal Uterine Bleeding, Reproductive Sciences, 16:2, pp 162-170 (2009) Makrides, M., Gibson, R.A., McPhee, A.J., Collins, C.T., Davis, P.G., Doyle, L.W., Simmer, K.N., Colditz, P.B., Morris, S., Smithers, L.G., Willson, K. and Ryan, P. Neurodevelopmental Outcomes of Preterm Infants Fed High-Dose Docosahexaenoic Acid, Journal of American Medical Association, 301:2, pp 175-182 (2009) Maxwell, S.J., Molster, C.M., Poke, S.J. and O'leary, P.C. Communicating Familial Hypercholesterolemia Genetic Information Within Families, Genetic Testing and Molecular Biomarkers, 13:3, pp 301-306 (2009) Measey, M.A., d'Espaignet, E.T., Charles, A.K. and Douglass, C. Unexplained fetal death: Are women with a history of fetal loss at higher risk?, Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: pp 151-157 (2009) Michener, C. and Dickinson, J.E. Caesariean scar ectopic pregnancy: A single centre case series, Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: pp 451-455 (2009) Misra, D.P., Salafia, C.M., Miller, A.K. and Charles, A.K. Non-Linear and Gender-Specific Relationships Among Placental Growth Measures and The Fetoplacental Weight Ratio, Placenta, 30: pp 1052-1057 (2009)
Hillman, N., Pillow, J.J., Ball, M.K., Polglase, G.R., Kallapur, S.G. and Jobe, A. Antenatal and postnatal corticosteroid and resuscitation induced lung injury in preterm sheep, Respiratory Research, doi:10.1186/1465-9921-10-124: (2009) Holder, G.L., Doherty, D.A. and Patole, S.K. Elective red cell transfusions for anemia of prematurity and development of necrotising enterocolitis in previously well preterm neonates: Incidence and difficulties in proving a cause-effect relation, Journal of NeonatalPerinatal Medicine, 2: pp 181-186 (2009) Howman, R.A., Barr, A.L., Shand, A.W. and Dickinson, J.E. Antenatal Intravenous Immunoglobulin in Chronic Immune Thrombocytopenic Purpura: Case Report and Literature Review, Fetal Diagnosis and Therapy, 25: pp 93-97 (2009) Hulskamp, G., Lum, S., Stocks, J., Wade, A., Hoo, A.F., Costeloe, K., Hawdon, J., Deeptha, K. and Pillow, J.J. Association of prematurity, lung disease and body size with lung volume and ventilation inhomogeneity in unsedated neonates: a multicentre study, Thorax, 64: pp 240-245 (2009) Hunter, T. and Hart, R.J. Endoscopic surgery for female infertility: A review ofcurrent management, Australian and New Zealand Journal of Public Health, 49: pp 588-593 (2009) Hunter, T.J., Maouris, P. and Dickinson, J.E. Prenatal Detection and Conservative Management of a Partial Fundal Uterine Dehiscence, Fetal Diagnosis and Therapy, 25: pp 123-126 (2009)
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Molster, C., Samanek, A., Bower, C. and O'leary, P.C. A survey of folate knowledge and consumer behaviours in Western Australia prior to the introduction of mandatory food fortification, Australian and New Zealand Journal of Public Health, 33: pp 577-582 (2009) Newnham, J.P., Newnham, I.A., Ball, C.M., Wright, M., Pennell, C.E., Swain, J. and Doherty, D.A. Treatment of Periodontal Disease During Pregnancy, Obstetrics and Gynecology, 114:6, pp 1239-1248 (2009) Ong, M.J., Guelfi, K.J., Hunter, T., Wallman, K.E., Fournier, P.A. and Newnham, J.P. Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant woman, Diabetes and Metabolism, 35: pp 418-421 (2009) Pennell, C.E., Palmer, l.J., Knight, B.S., Relton, C. and Lye, S. Approaches to Evaluate Gene-Environment Interactions Underlying the Developmental Origins of Health and Disease, Early Life Origins of Humans Health and Disease, ed J.P. Newnham, M.G. Ross, Switzerland, Karger, pp 205-217 (2009) Pennell, C.E., Henderson, J.J., O'Neill, M.J., McCleery, S., Doherty, D.A. and Dickinson, J.E. Induction of labour in nulliparous women with an unfavourable cervix: a randomised controlled trial comparing double and single balloon catheters and PEG2 gel, British Journal of Obstetrics and Gynaecology, 116: pp 1443-1452 (2009) Pillow, J.J., Hillman, N.H., Polglase, G.R., Moss, T.J., Kallapur, S.G., Cheah, F-C., Kramer, B.W. and Jobe, A. Oxygen, temperature and humidity of inspired gases and their influences on airway and lung tissue in near-term lambs, Intensive Care Medicine, 35: pp 2157-2163 (2009) 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 Contimuous Positive Airway Pressure or Conventional Ventilation, Pediatric Research, 65:1, pp 67-71 (2009) Pugh, S., Doherty, D.A., Magann, E.F., Chauhan, S.P., Hill, J.B. and Morrison, J.C. Does hypoglycemia following a glucose challenge test identify a high risk pregnancy, Reproductive Health, doi:10.1186/17424755-6-10: (2009) Rao, S., Srinivasjois, R. and Patole, S.K. Prebiotic supplementation in full-term neonates, Archives of Pediatrics & Adolescent Medicine, 163:8, pp 755-764 (2009) Rao, S., Pirie, S., Minutillo, C., Gollow, I., Dickinson, J.E. and Jacoby, P. Ward reduction of gastroschisis in a single stage without general anaesthesia may increse the risk of short-term morbidities: Result of a prospective audit, Journal of Paediatrics and Child Health, 45: pp 384388 (2009) Robinson, M., McLean, N.J., Oddy, W.H., Mattes, E., Bulsara, M., Li, J., Zubrick, S.R., Stanley, F.J. and Newnham, J.P. Smoking cessation in pregnancy and the risk of child behavioural problems: A longitudinal prospective cohort study, Journal of Epidemiology & Community Health, doi:10.1136/jech.2009.088658: (2009) Schulzke, S., Polglase, G.R., Sozo, F. and Pillow, J.J. Feasibility and Short-Term Effects of Biphasic Positive Airway Pressure Versus Assist-Control Ventilation in Preterm Lambs, Pediatric Research, 66:6, pp 665-670 (2009) Schulzke, S.M., Hall, G.L., Nathan, E.A., Simmer, K.N., Nolan, G. and Pillow, J.J. Lung Volume and Ventilation Inhomogeneity in Preterm Infants at 15-18 Months Corrected Age, The Journal of Pediatrics, doi:10.1016/j.jpeds.2009.10.01: (2009)
Shand, A.W., Hornbuckle, J., Nathan, E., Dickinson, J.E. and French, N. Small for gestational age preterm infants and relationship of abnormal umbilical artery Doppler blood flow to perinatal mortality and neurodevelopmental outcomes, Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: pp 52-58 (2009) Shynlova, O., Chow, M. and Lye, S. Expression and Organisation of Basement Membranes and Focal Adhesion Proteins in Pregnant Myometrium is Regulated by Uterine Stretch, Reproductive Sciences, 16:10, pp 960-969 (2009) Shynlova, O., Tsui, P., Jaffer, S. and Lye, S. Integration of endocrine and mechanical signals in the regulation of myometrial functions during pregnancy and labour, European Journal of Obstetrics & Gynecology and Reproductive Biology, 144: pp S2-S10 (2009) Simmer, K.N. and Hartmann, B.T. The knowns and unknowns of human milk banking, Early Human Development, 85: pp 701-704 (2009) Srinivasjois, R., Rao, S. and Patole, S.K. Prebiotic supplementation of formula in preterm neonates: A systematic review and meta-analysis of randomised controlled trials, Clinical Nutrition, 28: pp 237-242 (2009) Strunk, T., Doherty, D., Richmond, P.C., Simmer, K.N., Charles, A.K., Levy, O., Liyanage, K.E., Smith, T., Currie, A.J. and Burgner, D.P. Reduced levels of antimicrobial proteins and peptides in human cord blood plasma, Archives of Disease in Childhood, Fetal and Neonatal Edition, 94: pp F230-F231 (2009) Tagare, A., Kadam, S., Vaidya, U., Pandit, A. and Patole, S.K. A Pilot Study of Comparison of BCPAP vs. VCPAP in Preterm Infants with Early Onset Respiratory Distress, Journal of Tropical Pediatrics, Advance Access: (2009) Tulic, M.K., Sly, P.D., Andrews, D., Crook, M., Davoine, F., Odemuyiwa, S.O., Charles, A.K., Hodder, M.L., Prescott, S.L., Holt, P.G. and Moqbel, R. Thymic indoleamine 2,3-dioxygenase-positive eosinophils in young children: potential role in maturation of the naive immune system, The American Journal of Pathology, 175:5, pp 2043-2052 (2009) Weisberg, E., Hickey, M., Palmer, D., O'Connor, V., Salamonsen, L.A., Findlay, J.K. and Fraser, I.S. A randomized controlled trial of treatment options for troublesome uterine bleeding in Implanon users, Human Reproduction, 24:8, pp 1852-1861 (2009) White, L., Suganthini, G., Friis, R., Dharmarajan, A. and Charles, A. Expression of secreted frizzled-related protein 4 in the primate placenta, Reproductive Bio Medicine Online, 18:1, pp 104-110 (2009) White, L.J., Declerq, W., Arfuso, F., Charles, A.K. and Dharmarajan, A.M. Function of caspase-14 in trophoblast differentiation, Reproductive Biology and Endocrinology, doi: 10.1186/1477-7827-7-98.: (2009) Whitehouse, A., Maybery, M., Hart, R., Sloboda, D.M., Stanley, F.J., Newnham, J.P. and Hickey, M. Free testosterone levels in umbilicalcord blood predict infant head circumference in females, Developmental Medicine and Child Neurology, 52:3, pp e73-e77 (2009) Yeganegi, M., Watson, C.S., Martins, A., Kim, S.O., Reid, G., Challis, J. and Bocking, A.D. Effect of Lactobacillus rhamnosus GR-1 supernatant and fetal sex on lipopolysaccharide-induced cytokine and prostaglandin-regulating enzymes in human placental trophoblast cells: implications for treatment of bacterial vaginosis and prevention of preterm labor, American Journal of Obstetrics and Gynecology, 200: pp 532.e1-532.e8 (2009)
Publications in peer review scientific journals (January 2010 - June 2010)
image courtesy of The West Australian
Allanson B, Jennings B, Jacques A, Keil A, Charles AK, Dickinson JE. Infection and fetal loss in the mid second trimester of pregnancy. Aust NZ J Obstet Gynaecol, 50: pp 251-4 (2010) Aye ILMH, Waddell BJ, Mark PJ, Keelan JA. Placental ABCA1 and ABCG1 transporters efflux cholesterol and protect trophoblasts from oxysterol induced toxicity. Biochemica et Biophysica Acta, 1801: pp 1013-1024 (2010) Baynam G, Kiraly-Borri C, Goldblatt J, Dickinson JE, Overkov A. A recurrence of a hydropic lethal skeletal dysplasia showing similarity to Desbuquois Dysplasia and a proposed new sign: The Upsilon sign. American Journal of Medical Genetics A, 152A(4): pp 966-9 (2010) De Silva D, Mitchell MD, Keelan JA. Inhibition of choriodecidual cytokine production and inflammatory gene expression by selective IkB kinase (IKK) inhibitors. British Journal of Pharmacology, 160: pp 1808-1822 (2010) Dickinson JE, Brownell P, McGinnis K, Nathan E. Mifepristone and second trimester pregnancy termination for fetal abnormality in Western Australia: worth the effort. Australian and New Zealand Journal of Obstetrics and Gynecology, 50: pp 60-64 (2010) Dickinson JE, Sharpe J, Warner TM, Nathan E, D’Orsogna L. Childhood cardiac function following severe red cell isoimmunisation. Obstetrics and Gynecology, 116(4): pp 851-7 (2010) Garry R, Hart R, Karthigasu KA, Burke C. Structural Changes in Endometrial Basal Glands During Menstruation. In press British Journal of Obstetrics and Gynaecology, epub ahead of print Jun 18 (2010) Glujovsky D, Pesce R, Fiszbajn G, Sueldo C, Hart R, Ciapponi A. Endometrial Preparation For Women Undergoing Embryo Transfer With Frozen Embryos Or Embryos Derived From Donor Oocytes. Review In: Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD006359. DOI: 10.1002/14651858.CD006359.pub2.
Hart R, Doherty DA, Hickey M, Norman RJ, Franks S, Dickinson JE, Sloboda DM. Anti-Mullerian Hormone (AMH) levels are elevated in adolescent girls with polycystic ovaries and the Polycystic Ovarian Syndrome (PCOS). Fertility and Sterility, 94: pp 1118-21 (2010) Hart R, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database of Systematic Reviews, Issue 7 (2010) Hart R, Sloboda DM, Doherty DA, Norman RJ, Atkinson HC, Newnham JP, Dickinson JE, Hickey M. Circulating maternal testosterone concentrations at 18 weeks of gestation predict AMH in adolescence: Fertility and Sterility,94(4): pp 1544-7 (2010) Hickey M, Doherty DA, Hart R, Norman RJ, Mattes E, Atkinson HC, Sloboda DM. Maternal and umbilical cord androgen concentrations do not predict digit ratio (2D:4D) in girls: a prospective cohort study. Psychoneuroendocrinology, 35(8): pp 1235-44 (2010) Hickey M, Emery L, Gregson J, Doherty DA, Saunders CM. ‘The multidisciplinary management of menopausal symptoms after breast cancer: a unique model of care’, Menopause 2010; 17(4):727-733. Hillman, N.H., Kallapur, S.G., Pillow, J.J., Moss, T.J., Polglase, G.R., Nitsos, I. and Jobe, A. Airway Injury From Initiating Ventilation in Preterm Sheep, Pediatric Research, 67:1, pp 60-65 (2010) Jackson CR, Orford J, Minutillo C, Dickinson JE. Dilated and echogenic fetal bowel and postnatal outcomes: a surgical perspective – Case series and literature review. European Journal of Pediatric Surgery, 20: pp 191-3 (2010) Jones ML, Mark PJ, Lewis JL, Mori TA, Keelan JA, Waddell BJ. Antioxidant defenses in the rat placenta in late gestation: Increased labyrinthine expression of superoxide dismutases, glutathione peroxidase 3, and uncoupling protein 2. Biology of Reproduction, 83: pp 254-260 (2010)
P ublications
P ublications
Jones ML, Lewis JL, Mark PJ, Mori TA, Keelan JA, Waddell BJ. Antioxidant defenses in the rat placenta: increased labyrinthine expression of superoxide dismutases, glutathione peroxidase-3 and uncoupling protein-2 in late gestation. Biology of Reproduction, 83: pp 254-260 (2010) Keelan JA, Wong P-M, Bird PS, Mitchell MD. Innate inflammatory responses of human decidual cells to periodontopathic bacteria. American Journal of Obstetrics and Gynecology, 202(5):471.e1-11 (2010) Kemp MW, Saito M, Newnham JP, Nitsos I, Okamura K, Kallapur SG. Preterm birth, infection, and inflammation advances from the study of animal models. Reproductive Sciences, 17(7): pp 619-628 (2010) Knox CL, Dando SJ, Nitsos I, Kallapur SG, Jobe AH, Payton D, Moss TJ, Newnham JP. The severity of chorioamnionitis in pregnant sheep is associated with in vivo variation of the surface-exposed multiplebanded antigen/gene of Ureaplasma parvum. Biology of Reproduction, 83(3): pp 415-26 (2010) Kramer, B.W., Kallapur, S.G., Moss, T.J., Nitsos, I., Polglase, G.R., Newnham, J.P. and Jobe, A. Modulation of fetal inflammatory response on exposure to lipopolysaccharide by chorioamnion, lung, or gut in sheep, American Journal of Obstetrics and Gynecology, 202: 77.e177.e9 (2010) Lewis L, Doherty D, Hickey M, Skinner S. Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy. Contraception, 81(5) pp 421-426 (2010) Lewis L, Doherty D, Hickey M, Skinner S. Predictors of sexual intercourse and repeat pregnancy amongst teenage mothers: an Australian prospective longitudinal study. Medical Journal of Australia, 193 (6) pp 338-342 (2010) Magann EF, Doherty DA, Lutgendorf MA, Magann M, Chauhan SP, Morrison JC. ‘Peripartum outcomes of high-risk pregnancies complicated by oligo- and poly-hydramnios: a prospective longitudinal study’, J Obstet Gynaecol Res; 36(2):268-277 (2010) Patton K, Murch A, Goldblatt J, Wetherall J, Doherty D, Hadlow N. ‘Rate of X chromosome aneuploidy in young fertile women: comparisons of cultured and uncultured cell preparations using fluorescence in situ hybridisation’, Aust NZ J Obstet Gynecol; 50(4):378381 (2010) Raval AD, Hunter T, Stuckey B, Hart RJ. Statins for women with polycystic ovary syndrome not actively trying to conceive. Cochrane protocol 402909100100305434 In Press 2010 Issue 7. Robinson, M., Mattes, E., Oddy, W. H., Pennell, C.E., Van Eekelen, J.A.M., McLean, N. J., Jacoby, P., LI J., De Klerk, N.H., Zubrick S.R., Stanley, F.J., Newnham, J.P. Prenatal stress events and behavioural development from age two to 14 years: The influence of the number, type and timing of stressful life experiences. Development and Psychopathology. Accepted 30th June 2010. (In press). Robinson, M., Oddy, W. H., McLean, N. J., Jacoby, P., Pennell, C.E., de Klerk, N. H., Zubrick, S.R., Stanley, F.J. & Newnham, J.P. (in press). Low-moderate prenatal alcohol exposure and risk to child behavioural development: A prospective cohort study. British Journal of Obstetrics and Gynaecology, 117(9): pp 1139-1152 (2010) Shah, TA, Hillman, N, Nitsos, I, Polglase, G, Pillow, JJ, Newnham, JP, Jobe, AH, Kallapur, SG. Pulmonary and systemic expression of monocyte chemotactic proteins in preterm sheep fetuses exposed to LPS induced chorioamnionitis. Pediatric Research, 68(3): pp 210-5 (2010)
Singh A, Keelan JA, Sieg F. A novel neuronal regeneration peptide (NRP) promotes trophoblast survival and migration. Reproductive Biomedecine Online, 2010 [Apr 4, EPub ahead of print]. Swalm D, Brooks J, Nathan L, Jacques A, Doherty D. ‘Using the Edinburgh Postnatal Depression Scale to Screen for Perinatal Anxiety’, Arch Womens Ment Health 2010 Jun 24 [Epub ahead of print]. Tang H, Hunter T, Hu Y, Zhai S, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane protocol 907009090302205433 In Press, Issue 7 (2010) White, C. R., D. A. Doherty, et al. "Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit." Australian and New Zealand Journal of Obstetrics and Gynaecology, 50(4): pp 318-28 (2010) Whitehouse AJO, Maybery MT, Hart R, Mattes E, Newnham JP, Sloboda DM, et al. Fetal androgen exposure and pragmatic language ability of girls in middle childhood: Implications for the extreme malebrain theory of autism. Psychoneuroendocrinology, 35(8): pp 1259-64 (2010) Whitehouse AJO, Maybery MT, Hart R, Sloboda DM, Stanley FJ, Newnham JP, Hickey M. Umbilical cord free testosterone levels predict infant head circumference in girls. Developmental Medicine and Child Neurology, 52(3):e73-7 (2010)
science for human health
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