4th fact

 

Of about 32,000 births each year in WA, approximately 2,800 are preterm and this figure is rising.

2007 Annual Report

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Women and Infants Research Foundation
Annual Report 2007 Affiliated with The University of Western Australia and King Edward Memorial Hospital
Carson House King Edward Memorial Hospital 374 Bagot Road Subiaco Western Australia 6008 Postal address PO Box 134 Subiaco Western Australia 6904 Telephone Facsimile Website email (08) 9340 1437 (08) 9340 1642 www.wirf.com.au wirf@obsgyn.uwa.edu.au
Honorary Life Members Mrs Janet Holmes à Court Mr John Rawlinson Emeritus Professor Con Michael Mr Rod Maslin
Contents
Our Mission and Prime Areas of Research Honorary Board of Management Chairperson’s Report Director’s Report Governance Statement Grant Funding Research Units Biostatistics and Research Design Unit The Lotteries Commission / Women and Infants Research Foundation Perinatal Research Laboratories Women and Infants Research Foundation / UWA School of Women’s and Infants’ Health Laboratories Perron Rotary Express Milk Bank (PREM Bank) Research Reports Preventing Preterm Birth: The Possible Role of Periodontal Disease Prediction and Prevention of Preterm Labour using Molecular Genetics Fetal Futures Program Pain Relief and Anaesthesia Newborn Nutrition Neonatal Infection Neonatal Gastrointestinal Disease Antidepressant Medication Use in Pregnancy Neonatal Respiratory Medicine Flight After Preterm Birth Long Term Follow Up after Preterm Birth Breastfeeding Research The Origins of the Polycystic Ovary Syndrome Menopausal Symptoms following Breast Cancer Midwifery Substance Use in Pregnancy Teenage Pregnancy Intention, Contraceptive Use and Repeat Pregnancy Publications Our Heartfelt Thanks Major Supporters Donors Volunteers Research Support Financial Statements 2 3 4 5 7 8 10 10 11 12 13 14 14 16 19 20 21 22 23 23 24 25 25 26 29 30 31 32 33 34 38 38 40 40 42 44
WIRF Annual Report 2007 Page 2
Our Mission and Prime Areas of Research 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 of all ages, and health and disease of early life and their influence on subsequent health and disease in later life.
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
• • • • • • • Prevention of brain damage. Preventing and reducing the dangers of preterm birth. The fetal origins of childhood and adult illness. Improving pain relief in labour and after surgery. Prevention of postnatal depression. Promotion and evaluation of breastfeeding. Women’s health problems in later life including menopause and cancer.
Organisational Chart
Honorary Board of Management Honorary Director Deputy Director Finance Investment Committee Marketing & Development Administration Assistant Biostatistics & Research Design Unit Core Clinical Research Staff Volunteers Café & Gift Shop Baby Photography Scientific Grants Advisory Committee Annual Research Grant Scheme
Lotteries Commission Perinatal Research Laboratories (UWA Campus)
Women and Infants Research Foundation/ The University of Western Australia Laboratories
Clinical Fellow Programme Maternal Fetal Medicine Newborn Medicine
WIRF Annual Report 2007 Page 3
Honorary Board of Management
The Board of Management provides strategic direction to Foundation management to ensure the quality, efficiency and longevity of our research, and clinical and community activities. The Board meets six times a year. All Board members serve on a voluntary basis.
Chairperson
Ms Anne Payne Solicitor
Ms Andrea Burns Journalist Ms Robyn Collins Acting Executive, Director of Midwifery and Nursing King Edward Memorial Hospital Mr Jim Davies Managing Director Marketing Mrs Nicola Forrest Company Director Professor Peter Hartmann Professor of Biochemistry The University of Western Australia Chairman, Scientific Grant Advisory Committee Women and Infants Research Foundation Mr Peter Hawkins Company Director
Mr Gerald Major Property Consultant Professor Michael Paech Director of Research, Anaesthesia Department King Edward Memorial Hospital Dr Craig Pennell Senior Lecturer, School of Women’s and Infants’ Health The University of Western Australia Certified Subspecialist in Maternal Fetal Medicine King Edward Memorial Hospital Ms Jann Rowley Artist Professor Karen Simmer Professor of Neonatal Medicine The University of Western Australia Medical Director, Neonatology Clinical Care Unit King Edward Memorial & Princess Margaret Hospitals
Deputy Chairperson and Treasurer
Mr Alan Good Chartered Accountant
Director
Professor John Newnham Professor, Maternal Fetal Medicine King Edward Memorial Hospital Head, School of Women’s and Infants’ Health The University of Western Australia
WIRF Annual Report 2007 Page 4
Chairperson’s Report
It gives me great pleasure to present this year’s Annual Report. This is the 31st year of the Foundation and we have much to celebrate.
The sound financial position of the Foundation now enables expansion into exciting new areas of research, and further investment in those areas in which we perform highly. During the year, as a strategic priority, the Board allocated the resources required to seek and appoint a senior laboratory scientist to provide leadership in our laboratories, and to provide the resources for further developments in that area. The Board now has welcomed Associate Professor Jeffery Keelan who has moved from Auckland in New Zealand to take up the position. We look forward to exciting new advances in that area under Professor Keelan’s leadership. During this year we have changed the format of Board meetings to include regular presentations from the organisation’s senior researchers. Each meeting now commences with a presentation by a researcher, or has a similar presentation focusing on an area of activity. This initiative has been welcomed by the Board members and during the coming year will be expanded to include site visits where appropriate. We welcomed new Board members during the year – Nicola Forrest who brings expertise in business management, Andrea Burns who brings expertise in journalism and Dr Craig Pennell as the Clinical Staff Association representative. We said farewell to Professor Mike Paech, and, more recently, Robyn Collins who left to take a senior position within the Health Department. We thank them for their valuable contributions over the years and wish them all the very best in the future. The sound financial position of the Foundation has resulted from hard work and commitment of many people. At the heart of the organization lies a business philosophy of raising funds for research by providing services to patients and staff on the campus. This policy underpins our business ventures, each of which is proving to be productive. The Café and Gift Shop, managed by Annemarie Weekes, continues to be of great value. Much of the high profit margin results from the endeavours of our 70 volunteers and the Board remains very grateful for their hard work, commitment and loyalty. The photography business is also proving to be a success and we thank the senior photographer Julie Rutgers. Many community groups continue as strong partners of the Foundation. In particular, on behalf of the Board I would like to thank the Channel 7 Telethon Trust, The Lions Clubs of Thornlie and Belmont, The Stan Perron Charitable Trust, Rotary and Mr and Mrs Andrew and Nicola Forrest. Finally, I would like to extend thanks to those leaders whose daily works underpins the success of the organization – Professor John Newnham who is our Honorary Director, Dr Dorota Doherty who heads our Biostatistics and Research Design Unit, Dr Graeme Polglase who heads the Lotteries Commission Perinatal Research Unit, Paquita Sutherland who is our Marketing and Development Manager, Chris Spencer who is the Foundation’s secretary, and the many other scientists, medical practitioners, midwives, nurses, allied health practitioners and patients whose commitment is making the Foundation such a success. Together, we can be confident we are making a difference to the lives of many women, children and their families. Anne Payne Honorary Chairperson
WIRF Annual Report 2007 Page 5
Director’s Report
Welcome to the 31st Annual Report of the Women and Infants Research Foundation.
Since the Foundation was formed in 1976, it has functioned as the sole organization in Western Australia dedicated to supporting research in the fields of women’s health and reproduction. As such, it has played a central role in the growth and development of research in these fields locally and has contributed greatly to the high standard of health care enjoyed by women and infants in this State and elsewhere. Its strong financial position now allows for further expansion with exciting developments in vital new areas of research and education. Western Australia (UWA). The Foundation conducts research both in its own right and in partnership with these and other organizations. Co-location of the research, clinical, educational and administrative functions provides an ideal environment for clinical science and is paying dividends in improved clinical practice. An increasing number of national and international collaborations are also expanding the Foundation’s horizons and providing opportunities for knowledge transfer, external funding and scientific discovery.
Research activities
The fields of women’s health and reproduction are broad. Medically, these fields are known as obstetrics, gynaecology and newborn medicine. Within these are more than a hundred major topics requiring ongoing research activities, ensuring a need for strategic planning to focus on those areas in which our investment is most likely to benefit the women and infants of Western Australia. The major areas of research, and brief descriptions of the projects, are described in this Report. I trust you will find reading the Report to be informative and enjoyable. Much of the success of our research program arises from support provided by the Biostatistics and Research Design Unit, headed by Dr Dorota Doherty. The Unit was expanded recently with the addition of two half-time biostatisticians and a computer programmer, and the additional resources have resulted in a marked increase in research output.
Expansion of our Research Laboratories
The very strong clinical research base of the Foundation is benefiting from further investment in our research laboratories. With support provided by a building grant from UWA, and equipment purchases through donations from Lions Clubs, the laboratories have been rebuilt to allow for expansion. During the year, the re-building has provided dedicated rooms for DNA and RNA-based research, more office space, and plans are in place for a new tissue culture laboratory. During the year, the Board allocated funds for recruitment of a senior laboratory scientist to take the leadership role in this aspect of the Foundation’s activities. The position attracted a pool of talented applicants from Australia and overseas. The Board is pleased to announce that the position has been taken by Associate Professor Jeffery Keelan who previously headed pregnancy research at the Liggins Institute in Auckland, New Zealand. Professor Keelan will commence in this position in July 2007. We look forward to exciting new research directions that we know will be brought to Western Australia by Associate Professor Keelan. Also during the year we said farewell to Dr Deborah Sloboda. Dr Sloboda came to us from the University of Toronto for a 5-year postdoctoral fellowship, funded largely by a Forrest Fellowship. She played a central role in the re-establishment of our basic
Partnerships
The Foundation enjoys strong and enduring partnerships on the campus of the tertiary level women’s hospital. On this campus, clinical services are provided by King Edward Memorial Hospital and the principal link to academia is through the School of Women’s and Infants’ Health of The University of
WIRF Annual Report 2007 Page 6
Director’s Report continued... HEADINGS
science laboratories, strengthened our collaborative ties with Canadian researchers, and completed several landmark studies on fetal development. We are grateful for the substantial contributions she made during her time with us and we wish her all the very best for her future career in science. The Perinatal Research Laboratories on the UWA Crawley Campus have also undergone a change in leadership this year. The Laboratories were commenced in 1999 by Dr Timothy Moss who came to us from Monash University in Victoria. Dr Moss played a central role in developing the facility and its research program. He now is returning to Melbourne where he will continue his career in perinatal research. On behalf of his many collaborating scientists and students, I thank Dr Moss for his outstanding contributions to the work of the Foundation. Dr Graeme Polglase has now been promoted to the position of Research Manager of the Perinatal Research Laboratories and we look forward to an exciting new era for this area of research.
Research Funding
The Board receives advice on much of its funding strategies from the Scientific Grants Advisory Committee, chaired by Professor Peter Hartmann. Like so many of the activities of this organization, each member of this Committee is a volunteer. During the year, the Committee judged applications for funding for Starter Grants, PhD Top-up Scholarships, Capacity Building Grants and appointment of the Senior Scientist to provide leadership in Laboratory Science. Their contributions are greatly appreciated.
Our Businesses
The Foundation aims to conduct businesses that provide the dual purpose of helping patients, visitors and staff on the hospital campus as well as raising money to support research. This is the ninth year of operation of the Café and Gift Shop and the Financial Statements reveal the great success of this business. The success results from the great need within the hospital for such a service; the outstanding leadership of the Manager, Annemarie Weekes; the hard work of our staff; and the dedication of our volunteers. Our team of approximately 70 volunteers is providing enthusiastic support that ensures this business is both popular and productive. On behalf of all the researchers working with the Foundation, and the women and infants who benefit from the scientific findings, I extend my sincere gratitude for their hard work and loyalty. I also wish to thank Julie Rutgers and Dawn O’Brien our Baby Photographers, Paquita Sutherland our Marketing and Development Manager, Chris Spencer, our Administration Assistant, our Accountant, Andrea Cole and Bookkeeper, Claire Williams along with our volunteers in the office who each continue to provide outstanding service for the Foundation.
DOHaD 2007
One of the objectives of the Foundation is to “inform and educate the scientific and wider community of the results and implications of its research”. For many years, this goal has underpinned support for local scientific meetings, but the aim now is to achieve a more international focus. WIRF is official partner of the International Society for the Developmental Origins of Health and Disease (DOHaD) in hosting the 5th International Congress of the Society at the Perth Convention Exhibition Centre, 6 – 10th November 2007. The DOHaD Society addresses the early origins of disease, with particular emphasis on the role of life before birth in subsequent health. The field of research, and the general aim of preventing diseases at their origins, is in synchrony with the research priorities of the Foundation. It is expected the Congress will attract more than 500 delegates, including 100 invited speakers. The truly international composition of the membership of this Society ensures that knowledge arising from the meeting will spread to communities throughout the world. Plans are also in place to ensure that information from the meeting is readily accessible to our general population.
The Board
Behind the daily activities of the staff and volunteers, sits a Board committed to achieving the aims and aspirations of the Foundation. Membership of the Board is diverse, providing a wealth of experience and knowledge. Many decisions made by the Board in past years are now bearing fruit and financial success is allowing the development of new plans. I would like to thank Ms Anne Payne, Chair of the Board, Mr Alan Good, Deputy Chair of the Board, and each of the Board members for their leadership and support during the year. The Foundation continues to grow and prosper. It plays a vital role in promoting, conducting and supporting high quality research in an environment of productive partnerships between clinicians, scientists, business men and women, and volunteers. Their individual and collective accomplishments under the banner of the Foundation are to be applauded and greatly appreciated.
Paquita Sutherland
Christine Spencer
Andrea Cole
Professor John Newnham Honorary Director
Claire Williams
Julie Rutgers
Dawn O’Brien
Paquita Sutherland – Marketing and Development Manager Christine Spencer – Administration Assistant Andrea Cole – Accountant Claire Williams – Bookkeeper Julie Rutgers – Baby Photographer Dawn O’Brien – Baby Photographer
WIRF Annual Report 2007 Page 7
Governance Statement
Board of Directors
The Board of Management provides strategic direction to Foundation management to ensure the quality, efficiency and longevity of our research, clinical and community activities. The Board meets six times each year, all Board Members serve on a voluntary basis.
Scientific Grants Advisory Committee
The Committee is chaired by 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 honorary 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 Grant and PhD Scholarships.
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 Children’s Health Service and / or the Human Research Ethics Committee and Animal Ethics Committee of The University of Western Australia.
Chairperson
Professor Peter Hartmann Professor of Biochemistry The University of Western Australia Professor John Newnham Professor, Maternal Fetal Medicine Director, Women and Infants Research Foundation Head, School of Women’s and Infants’ Health The University of Western Australia Professor Karen Simmer Professor of Neonatal Medicine The University of Western Australia Medical Director, Neonatology Clinical Care Unit King Edward Memorial and Princess Margaret Hospitals Professor Brendan Waddell Head, School of Anatomy and Human Biology The University of Western Australia Dr Daniela Ulgiati Research Fellow Biochemistry and Molecular 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 Women and Children’s Health Service, irrespective of whether they have direct contact with WCHS children.
Financial Reporting
The Foundation’s financial year ended on 30th of June 2007. 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 2007 are available on www.wirf.com.au
Audit Governance
The Foundation engages WHK Horwath as an external audit team to independently review its financial reports and uphold the integrity of the reporting process.
Not for Profit Status
The Foundation operates as an incorporated not for profit organisation. The Australian Taxation Office has endorsed the Foundation as an Income Tax Exempt Charitable Entity and a Deductible Gift Recipient, this status ensures that anyone donating to the Foundation can claim the full tax benefit. The Foundation also holds a Charitable Collections Licence from the Department of Consumer and Employment Protection in Western Australia.
WIRF Annual Report 2007 Page 8
Grant Funding
Starter Grants Funded by the Foundation 2006/2007
“Feeding and Sleeping Outcomes of NICU Graduates and Healthy Term Babies”
Amount funded Ms S L Zuiderduyn King Edward Memorial Hospital Associate Professor J Fenwick School of Nursing and Midwifery, Curtin University of Technology and King Edward Memorial Hospital Professor L Johnston Royal Children’s Hospital, University of Melbourne Ms E A Nathan Women and Infants Research Foundation and King Edward Memorial Hospital $15,000
“The Effects of an Antenatal Water-based Exercise Program in a High Risk Obstetric Population: A Pilot Study”
Amount funded $2,988 Dr T Power School of Women’s and Infants’ Health, The University of Western Australia and King Edward Memorial Hospital Professor J Newnham School of Women’s and Infants’ Health, The University of Western Australia and King Edward Memorial Hospital Dr K Wallman School of Human Movement and exercise Science, The University of Western Australia Ms K Guelfi School of Human Movement and exercise Science, The University of Western Australia
“The Effect of Early Life Stress on Adolescent HPA Function and Mental Health”
Amount funded $14,940 Dr J A M Van Eekelen The University of Western Australia and Telethon Institute for Child Health Research Dr C E Pennell King Edward Memorial Hospital and School of Women’s and Infants’ Health, The University of Western Australia Dr E Mattes Columbia University, New York, United States of America
“A Population Health Approach to Perinatal Mental Health”
Amount funded $5,562 Dr K E Thomas School of Women’s and Infants’ Health, The University of Western Australia
Capacity Building Grant Funded by the Foundation 2006/2007
In 2006 the Foundation established the Capacity Building Grant funding program. The Capacity Building Grants are part of a wider strategy designed to nurture and develop promising researchers in line with the Foundation’s mission. The grants provide flexible support to allow investigators to develop their capacity to assist them in attaining a level of productivity and capability sufficient to attract nationally competitive grant funding. The Foundation funds a maximum of two Capacity Building Grants per year. Successful applications reviewed by the Scientific Advisory Grants Committee receive $105,000 in funding over three years. In 2006 the following Capacity Building Grant was awarded:
“Transmission of Inflammatory Mediators in Preterm Rupture of Membranes”
Amount funded $13,000 Dr A W Gill Women and Children’s Health Service Dr A Keil Women and Children’s Health Service Dr D P Burgner School of Paediatrics and Child Health, The University of Western Australia
“Understanding ventilation of the preterm lung and implications for long term respiratory well being”
Dr JJ Pillow Brief Description The research area of the applicant involves the use of non-invasive respiratory tools to investigate the postnatal growth and development of the lung, and the consequences of preterm birth, antenatal exposures and events and acute/chronic respiratory disease on longer term respiratory wellbeing. This research is aimed at optimising the ventilation strategies in NICU patients.
“Effects of Intrauterine Inflammation on the Fetal & Neonatal Pulmonary Circulation”
Amount funded $13,000 Dr G R Polglase School of Women’s and Infants’ Health, The University of Western Australia Dr T J M Moss School of Women’s and Infants’ Health, The University of Western Australia
WIRF Annual Report 2007 Page 9
WIRF Annual Report 2007 Page 10
Research Units
Biostatistics and Research Design Unit
The Biostatistics and Research Design Unit provides biostatistical collaboration, consultation and quantitative resources for research conducted at King Edward Memorial Hospital and affiliated institutions. Main activities include study design, data collection methods, data analysis of completed studies, manuscript preparation, grant proposal preparation, conduct of independent interim analyses for clinical trials, review of grants and manuscripts, presentation of seminars on statistical methods in medical research, and student supervision. Our involvement in research projects 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, initial plans for data collection, advice on statistical methodology for data analysis, assistance with interpretation of previously compiled results or performing data analysis of a completed study. These short-term consultations often develop into ongoing collaborations. The majority of our activities involve long term collaborations on research studies that begin at study conception and continue until its completion and dissemination of results. The Unit members 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 a new study often begins by consulting with investigators to understand the study objectives, to select a study design and associated statistical methods that are most appropriate to answer a given clinical question. While designing a study, we always consider the effects of potential major confounding variables as these confounders may affect study outcomes even when they are not directly related to the outcome of interest. Once potential confounders are addressed, in the next step we consider whether a suitable stratification of participants is necessary when the study outcomes are expected to differ in distinct patient groups. The Unit’s involvement in the planning of experiments also includes the development of appropriate statistical approaches and computational algorithms to meet the needs that are project specific, as a part of the statistical analysis plan. Other important activities include preparation of randomisation schedules facilitating blinding of principal investigators whenever possible, involvement in all aspects of data management including design of data collection forms, design and maintenance of databases and data entry. We often monitor study progress and quality assurance by collating interim data summaries. We 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, all four Western Australian Universities and the University of Mississippi, United States of America. We look forward to meeting new challenges in women’s health and reproduction in the coming year. Dr Dorota Doherty Head, Biostatistics and Research Design Unit
Our involvement in research projects ranges from short-term consultations to ongoing long-term collaborations on studies supported by research funding.
Dorota Doherty
Elizabeth Nathan
Angela Jacques
James Humphreys
WIRF Annual Report 2007 Page 11
Research Units
The Lotteries Commission/Women and Infants Research Foundation Perinatal Research Laboratories
KEY HIGHLIGHTS
< The recruitment of a new PhD student, Gabby Musk. Gabby is a veterinary anaesthetist who will be supervised by Professor Karen Simmer, Dr Jane
Pillow and Dr Graeme Polglase. Gabby’s PhD focus is on High Frequency Jet Ventilation, and its appropriateness for clinical use on preterm infants.
< The recruitment of a new Research Assistant, Carryn McLean. Carryn is a valuable asset to the group strengthening our molecular and
morphometric abilities. Carryn will work alongside Dr Jane Pillow and Dr Graeme Polglase.
< The awarding of prestigious awards to two of our staff – Dr Jane Pillow was awarded a Sylvia & Charles Viertel Senior Medical Research
Fellowship whilst Dr Graeme Polglase was awarded a joint National Heart Foundation and NH&MRC Postdoctoral Fellowship. Dr Pillow was also successful in obtaining a NH&MRC project grant and an Ada Bartholomew Medical Research Trust Grant. The WIRF Perinatal Research Laboratories are housed on the main campus of The University of Western Australia and have been operational since the beginning of 1999. The Laboratories include a suite of offices for research staff and students, an operating theatre, several purposebuilt laboratories and large animal holding facilities, together forming one of the best facilities of its type in the world. Much of the cost of construction of the Laboratories, and purchase of many of the state-ofthe-art scientific instruments that are used by researchers working within this facility, was supported by grants from the Lotteries Commission and other agencies awarded to the Women and Infants Research Foundation. Staff and students based at the WIRF Perinatal Research Laboratories are involved in research studies including investigations into: the developmental origins of health and disease; fetal responses to intrauterine inflammation and its effects on development of the fetal brain and lungs; studies of new ventilation techniques aimed at improving preterm infants’ chances of survival and wellbeing; interactions between ventilation and pulmonary and systemic blood flow distribution; and fundamental aspects of fetal development. Financial support for these projects has been awarded from several local, national and international competitive granting bodies, including the Women and Infants Research Foundation, The National Health and Medical Research Council (Australia), The National Heart Foundation of Australia, The Child Health Research Foundation of WA, The Asthma Foundation of WA, the Canadian Institutes for Health Research and The National Institutes of Health (USA). The budget for projects conducted within the WIRF Perinatal Research Laboratories is sourced entirely from externally funded research grants. An ongoing commitment by WIRF to provide financial and infrastructural support for the running of the laboratories ensures that research grants are dedicated to funding only experimental work. For the past 7 years Dr Timothy Moss has managed the WIRF Perinatal Research Laboratories, and been an outstanding contributor to the success of the research group at the WIRF laboratories. We would all like to extend to Tim our fondest farewell as he heads back to Melbourne, and wish him all the best for his future endeavours. Dr Graeme Polglase has been appointed the new WIRF Perinatal Research Laboratories Manager. This year was an exciting year in our development with the construction of a new holding facility and laboratories at The University of Western Australia’s Shenton Park campus, with equipment generously supported by WIRF. These facilities will ensure the successful continuation of our research, and will allow us to maintain our edge as one of the foremost perinatal scientific research groups in the world. The facilities and support provided by WIRF have expanded the research capabilities of the Foundation and The University of Western Australia, and have contributed to the recruitment of research scientists and clinicians from Australia and overseas. Fruitful collaborations with researchers from Melbourne, Sydney, Adelaide, Brisbane, Canada, USA, Holland and Germany have been established as a result of the research capabilities of the Laboratories and the support provided by WIRF. Our research collaborations, excellent laboratory facilities, support from WIRF, and the dedication of researchers working within the Laboratories, will ensure that we continue our valuable contributions to improving the lives of people around the world. Dr Graeme Polglase Manager
The WIRF Perinatal Research Laboratories form one of the best facilities of its type in the world.
Graeme Polglase
Jane Pillow
Ilias Nitsos
Andrea Lee
Gabrielle Musk
Carryn McLean
WIRF Annual Report 2007 Page 12
Research Units
Women and Infants Research Foundation / UWA School of Women’s and Infants’ Health Laboratories
KEY HIGHLIGHTS
< Refurbishment with the creation of separate RNA, DNA and general laboratories. < Recruitment of a new Principal Research Fellow to the laboratories. n New PhD students. n Expansion of image analysis facilities.
The Women and Infants Research Foundation / UWA School of Women’s and Infants’ Health Laboratories are located on the second floor (A Block) in King Edward Memorial Hospital. The laboratories were extensively re-furbished in late 2001. Within the laboratories are separate suites for RNA, DNA and image analysis, in addition to a general biomedical research laboratory. The laboratories are designed to complement and enhance both clinical and basic research undertaken through the Foundation and University, as well as support research conducted in the Lotteries Commission / Women and Infants Research Foundation Perinatal Laboratories on The University of Western Australia campus in Crawley. Research projects undertaken in the laboratories are diverse and include studies investigating prevention of preterm birth; how the intrauterine environment plays a role in determining an individual’s susceptibility to diseases later in life (such as Type 2 diabetes, high blood pressure and obesity); possible links between periodontal disease and preterm birth; fetal exposure to inflammation and subsequent heart and lung problems at birth; the complications of hormone replacement therapy given for menopausal symptoms; and reproductive development and its effect on fertility later in life. During the year we have further refurbished and expanded the laboratories using funds primarily from a building grant from the Faculty of Medicine, Dentistry and Health Sciences at UWA. These modifications were completed in November 2006 and now allow us to perform studies on RNA, DNA and proteins in different laboratories, preventing interference and contamination. Most modern biomedical research methods are now available to us, including RNA and DNA extraction, PCR and real-time PCR, plasmid manipulation and gene cloning/ extension, nucleic acid in situ hybridization, protein extraction and concentration, gel electrophoresis, immunoblotting, immunoassay (ELISA), immunohistochemistry and a wide range of general analytical biochemistry. The Women and Infants Research Foundation and the School of Women’s and Infants’ Health have jointly funded a new room for our freezers. The ultra cold freezers and a new gas bank have been upgraded in a dedicated facility, in line with best practice defined by the Australian laboratory safety and security regulations, to safeguard our valuable collection of biological fluids and specimens.
This year we have also introduced a credentialing procedure for all staff who wishes to use the equipment. This process is particularly important for students and clinical researchers who may need additional training in the use of some of the more complex pieces of equipment. Our ongoing relationship with the Lions District 201W1 has been of great assistance in ensuring our laboratories remain internationally competitive through the addition of new, cutting edge equipment. In the last 6 years, Lions International has donated more than $210,000 in support of the research laboratories. This year through their kind generosity we have been able to expand our in-situ hybridization facilities, allowing us to better study gene expression in tissue sections. This new equipment augments the Lions Image Analysis Suite that was established several years ago. There are currently two Professors, two Associate Professors, one Senior Lecturer, three Postdoctoral Fellows, one Research Associate, four Research Assistants and two Research Midwives carrying out research projects in the laboratories. Currently, six PhD students and one Master student are based within the laboratories; three PhD students have completed their studies this year. More than ten medical students have also undertaken projects in the laboratories in the past four years. Sadly, this year we said goodbye to Dr Deborah Sloboda who has played a key role in the laboratory’s development over the past few years. We thank her for her efforts and wish her well in her new position in Auckland, New Zealand. However, we are very pleased to have successfully recruited a senior scientist to the laboratories, Associate Professor Jeffrey Keelan (who coincidentally originates from Auckland), who will arrive in July 2007. He has a wealth of experience in many aspects of pregnancy research, with a background in endocrinology, pharmacology, biochemistry, immunology and molecular and cell biology. We are looking forward to benefiting from his expertise and leadership, and expect many exciting developments in the near future. Shaofu Li Laboratory Manager
Shaofu Li
Jeff Keelan
Karen Bosel Blagica Penova-Veselinovic
WIRF Annual Report 2007 Page 13
Research Units
Perron Rotary Express Milk Bank (PREM Bank)
KEY HIGHLIGHTS
< This year the Milk Bank turned one and in it’s first year has screened 60 mothers who
donated 350 litres of milk.
< 145 litres of pasteurised human donor milk was given to 70 of KEMH’s most premature or
critically ill infants – more than double the number of recipient babies anticipated.
< To keep up with the demand of pasteurised human milk the Milk Bank has expanded to
include additional freezer space, a larger capacity pasteuriser and more staff.
Both governmental and medical professional organisations strongly recommend breastfeeding for all infants acknowledging benefits with respect to infant nutrition, gastrointestinal function, host defence and psychological wellbeing. As such, extraordinary efforts are made to encourage and support mother’s own milk feeding in neonatal intensive care units (NICU’s) internationally. However, mothers of preterm infants, in particular, face many challenges in providing sufficient milk for their child during hospitalisation. This may be due to maternal illness, difficulties in establishing or maintaining lactation or, particularly relevant in the Australian context, geographic isolation. Thus, there is a population of preterm infants who must be fed by an alternative source of nutrition to their own mother’s milk. To meet this need the PREM Bank has been established at King Edward Memorial Hospital for Women. To ensure that the process occurs safely the PREM Bank has developed and implemented rigorous donor screening procedures and processing standards that are consistent with the requirements for blood and tissue donation and meet the requirements of food manufacturing standards in Australia. The PREM Bank model is now being used by other units in Australia, and we are leading the way, in collaboration with the Australasian Tissue Banking Forum, towards a national network of human milk banks in Australia. It was expected that the PREM Bank would be required to feed 20-30 infants in the first year of operation, however, we have been able to provide over 145 litres of pasteurised donor human milk to 70 infants. The community response to the project has been extremely encouraging and we have accepted over 350 litres of donor milk from more than 60 donors. Due to a limited processing capacity and controlled establishment of a new clinical service in the hospital we have had to turn away many potential donors. The establishment of a world class clinical service that utilises best practice in human milk banking will, over the next 12 months, provide the foundation for the development of a research group associated with the PREM Bank to better understand the nutritional needs of preterm infants. The PREM Bank has been established through a successful collaboration between WIRF, King Edward Memorial Hospital for Women and The University of Western Australia with funding from the Rotary Clubs of Belmont and Thornlie, The Perron Charitable Trust and the Channel 7 Telethon Trust. Dr Ben Hartmann Manager (Scientist-In-Charge)
Both governmental and medical professional organisations strongly recommend breastfeeding for all infants acknowledging benefits with respect to infant nutrition, gastrointestinal function, host defence and psychological well being.
Amanda Peacock
Ben Hartmann
Tracy Sedgwick
WIRF Annual Report 2007 Page 14
Research Reports
Preventing Preterm Birth: The Possible Role of Periodontal Disease
WIRF is hosting a major research study investigating the possibility that treatment of gum disease (periodontal disease) may prevent some of the major complications of pregnancy. This study is known as The Smile Study. Pregnant women in Perth are invited to have screening and treatment performed at King Edward Memorial Hospital, the Oral Health Centre of Western Australia (OHCWA), Osborne Park Hospital, Joondalup Hospital, Swan Districts Hospital, Armadale Hospital and Rockingham Hospital. Preterm birth is one of the most serious complications of human pregnancy. In Australia, 7-8% of all births are preterm and the incidence in this country and elsewhere is rising. Research studies aimed at treating infections in the vagina, overcoming social problems in the woman’s life, or treating the early onset of uterine contractions, have all been unrewarding. We know that more than two-thirds of babies born at early gestational ages show signs of inflammation, but the source of that inflammation is unknown. The Smile Study will provide definitive scientific evidence of whether one source of that inflammation is gum disease. Studies conducted by ourselves and others have provided strong support for the possibility that periodontal disease may have important consequences during pregnancy. Inflamed gums may release into the woman’s blood stream a series of chemicals that can affect blood flow to the uterus and initiate labour. In a preliminary study performed in our own population, we also found evidence that periodontal disease may restrict fetal growth. The Smile Study is testing whether treatment of periodontal disease will prevent preterm birth, growth problems with the fetus, and preeclampsia (high blood pressure). Pregnant women in Perth are being offered a screening examination of their gums between 12 and 20 weeks of pregnancy. Those women found to have periodontal disease are then invited to participate in the treatment arm of the project. Briefly, this participation involves allocation at random (by a computer) to have full periodontal treatment during mid-pregnancy, or when the pregnancy is completed. The treatment is worth more than a thousand dollars, if costed at standard government rates. This study design is known as a randomised controlled trial, and is the most powerful method of evaluating a test or treatment in medicine. The treatment of periodontal disease is mechanical and is administered by research hygienists under the supervision of specialist periodontists. To answer the question, 1080 women with periodontal disease are required to participate. The study is proceeding on-time and onbudget and recruitment is expected to be completed by December 2007. The Smile Study is a major collaboration between WIRF, The UWA Schools of Women’s and Infants’ Health and Dentistry, and the Oral Health Centre of Western Australia (OHCWA). Most of the funding is provided by a grant from the National Health and Medical Research Centre (NHMRC). Funding has also been provided by the Channel 7 Telethon Trust and an educational grant from Colgate. The most important contribution to this study however is being made by the many women who are participating. On behalf of the research team, we thank these women and the staff in the many participating centres who are making this project a success.
Preterm birth is one of the most serious complications of human pregnancy.
John Newnham
Dorota Doherty
Craig Pennel
Antonia Shand
Renate McLaurin
Jonathan Swain
Ian A Newnham
Colleen Ball
Desiree Cavill
Dolores Gasbarro
WIRF Annual Report 2007 Page 15
Investigators
Making preterm birth safer WIRF / School of Women’s and Infants’ Health, The University of Western Australia Professor John Newnham MD FRANZCOG Dr Timothy JM Moss BSc (Hons) PhD Dr Ilias Nitsos BSc (Hons) PhD Dr Graeme R Polglase BSc(Hons) PhD Dr Jane Pillow FRACP PhD (Distinction) Dr Dorota Doherty BSc (Hons) PhD Adrian Jonker Cincinnati Children’s Hospital Medical Center, Ohio, USA Professor Alan H Jobe MD PhD Professor Machiko Ikegami MD PhD Dr Suhas G Kallapur MD Dr Noah Hillman MD University of Wuertzberg, Germany Dr Boris Kramer MD The Smile Study WIRF / School of Women’s and Infants’ Health, The University of Western Australia
Chief Investigators
Professor John Newnham MD FRANZCOG Dr Dorota Doherty BSc (Hons) PhD Dr Craig Pennell MBBS (Hons) FRANZCOG Dr Alexis Shub FRANZCOG Dr Antonia Shand FRANZCOG UWA School of Dentistry / Oral Health Centre of Western Australia Dr Jonathan Swain BDSc MDSc Dr Ian A Newnham MDSc FRACDS (Perio) Professor John McGeachie BDSc PhD DSc
Research Midwives
Colleen Ball RN RM BN Desiree Cavill RN RM Dolores Gasbarro RN RM BSc Nsg Hons Renate McLaurin RN RM BHlth Sc Cherry Young RN RM Melanie Mosey RN RM Sally Bakker RN RM
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 Brookshank Assoc Degree Dental Hygiene
Dental Assistant
Lorraine Howard Michelle Wright Esther Jansen
Major Sponsors
National Health and Medical Research Council, Australia Colgate-Palmolive Oral B Channel 7 Telethon Trust
Cherry Young
Belinda Orrock
WIRF Annual Report 2007 Page 16
Research Reports
Prediction and Prevention of Preterm Labour using Molecular Genetics
RESEARCH OUTCOMES AND HIGHLIGHTS
< The determination of the “genetic signature” for true preterm labour is an exciting breakthrough in research into preterm birth. < Distinct gene expression profiles in maternal white blood cells appear to predict delivery within 48 hours, delivery less than 34
weeks, and delivery less than 37 weeks gestation.
< The results of this year’s work have culminated in filing North American and world wide patents on the predictive “genetic
signature” for true preterm labour.
< The utilisation of new technologies has provided us with the opportunity to develop a new non-invasive method of accurately and
reliably diagnosing true preterm labour.
< The genomic aspects of the “Smile Study” have provided us with the opportunity to collaborate with word leaders from North
America, Europe and Asia as part of a World Health Organisation led international collaboration to perform a genome-wide association of preterm birth in multiple populations.
< Utilising cutting edge molecular genetic approaches will offer us the opportunity to gain a new insight into the relationship
between periodontal disease and preterm birth.
Overview of Research
The research program investigating the prediction and prevention of preterm labour utilising molecular genetics has three components: 1) the “true” preterm labour study; 2) identifying genetic markers of periodontal disease-associated preterm birth; and 3) the evaluation of gene-environment interactions underlying periodontal disease associated preterm birth. The “true” preterm labour study is investigating the clinical condition of threatened preterm labour. This condition, where women present to hospital with regular uterine contractions many weeks prior to their expected delivery, occurs in many women during pregnancy and accounts for one third of all antenatal hospital admissions for pregnant women. Fortunately most women who present with threatened preterm labour do not progress to preterm delivery; however, our ability to predict the 5% who will progress to delivery within 7-10 days is poor. Each year in Australia more than 120,000 women are admitted to hospital with threatened preterm labour, yet only 6000 of these deliver within 7-10 days. Utilising molecular genetic techniques, our research team has identified specific “genetic signatures” that accurately predict delivery within 48 hours, prior to 34 weeks and prior to 37 weeks gestation. These signatures will allow the development of new noninvasive methods of accurately and reliably diagnosing true preterm labour which will provide the means to effectively triage patients and so reduce demands on limited health care resources, to limit the use of existing approaches to those patients whose preterm birth is imminent and, to define targeted patient groups to test new therapeutic approaches to prevent preterm birth. There is a growing body of evidence suggesting an association between gum disease and preterm birth; however, potential mechanisms for this association have yet to be established. Utilising the principle that our group discovered in the “true preterm labour study”, we have been evaluating the effect of treatment of gum disease in pregnant women on patterns of gene activation in white blood cells. These studies will provide a genome wide evaluation of the potential mechanisms responsible for the association between gum disease and preterm birth. Further, they may offer novel targets for future treatment opportunities to prevent preterm birth. With the disclosure of the sequence of the entire human genome and the availability of high-throughput methods making genotyping of large numbers of samples faster and less expensive than ever, our ability to acquire genetic data has increased exponentially. Molecular genetic techniques have demonstrated that 30-60% of the risk of preterm birth is genetic. The “Smile Study”, conducted by members of our team over the last three years, offers the opportunity to investigate interactions between genetics and periodontal disease. When this study is complete during 2008, our team will be able to evaluate the association between variations in maternal genes regulating the immune system, periodontal disease and preterm birth. Further, through collaboration with the World Health Organization and the Preterm Birth International Collaborative, we will be able to participate in a multinational genome-wide association study of preterm birth. It is envisioned that these studies will identify “genetic fingerprints” for women at greatest risk of preterm birth which will enable targeted treatment and the prevention of preterm birth.
Craig Pennell
John Newnham
Stephen Lye
WIRF Annual Report 2007 Page 17
Chief Investigators
Dr Craig Pennell MBBS(Hons) PhD FRANZCOG CMFM Senior Lecturer in Maternal Fetal Medicine The University of Western Australia and the Women and Infants Research Foundation Professor John Newnham MBBS MD FRANZCOG CMFM DDU Professor of Maternal Fetal Medicine The University of Western Australia and the Women and Infants Research Foundation Professor Stephen Lye PhD Professor, Department of Obstetrics & Gynaecology, University of Toronto Associate Director and Vice President Research, Samuel Lunenfeld Research Institute, Mt. Sinai Hospital Toronto Professor Alan Bocking MD PhD Professor and Chairman, Department of Obstetrics & Gynaecology, University of Toronto
Researchers
Ms Karen Bosel BSc(Hons) Research Assistant Mrs Blagica Penova-Veselinovic BSc(Hons) Research Assistant
Major Sponsors
March of Dimes Birth Defects Foundation Raine Medical Research Foundation PSI Foundation in Ontario Canada
WIRF Annual Report 2007 Page 18
WIRF Annual Report 2007 Page 19
Research Reports
Fetal Futures Program
Advances in medical technology have enabled the recognition and treatment of several serious fetal conditions prior to birth. The first successful fetal therapy was the use of intrauterine blood transfusions in Rhesus disease, a condition where maternal antibodies directed at fetal red blood cell antigens produce severe anaemia by the destruction of circulating red cells in the fetus. The intrauterine transfusion of blood to correct severe fetal anaemia is now a standard practice in maternal fetal medicine units, with many thousands of children alive throughout the world due to the success of this treatment. The short term outcomes of surviving children from pregnancies complicated by severe Rhesus disease have been well-described, but there is a dearth of information upon the long term effects of fetal anaemia and its cyclical correction by intrauterine blood transfusion upon child and adolescent development. It is recognised that intrauterine events in the fetus can impact on adult morbidity. Low oxygen levels in the fetus, as occurs with severe anaemia, have the potential to alter the development of the heart muscle and its circulation. However, there is a lack of knowledge about the impact of fetal anaemia and its cyclical correction on the long term heart function of the surviving children. The aim of this study is to non-invasively assess the cardiac function of children who received blood transfusions as a fetus to investigate the impact of anaemia and hypoxia upon the developing fetal heart. We hypothesise that fetal hypoxia secondary to severe anaemia alters the development of the heart muscle and the coronary circulation. To investigate this hypothesis we plan to study the cardiac function of children and adolescents who received intrauterine transfusions for severe fetal anaemia secondary to red cell isoimmunisation between 1992 and 2002 at King Edward Memorial Hospital. This is the first study in an exciting project known as the Fetal Futures Program, a new research initiative between the Womens and Infants Research Foundation and the Channel 7 Telethon Trust. Over the next few years we plan to investigate the impact of several serious fetal conditions on subsequent childhood development. Many adult disorders have their origin from intrauterine fetal occurrences and the Fetal Futures Program is designed with the principal aim to assess the impact of fetal diseases upon childhood development.
Advances in medical technology have enabled the recognition and treatment of several serious fetal conditions prior to birth.
Investigators
Associate Professor Jan Dickinson FRANZCOG Professor John Newnham MD FRANZCOG Dr Luigi D’Orsogna MBBS FRACP Mrs Joan A Sharpe M Cardiac Ultrasound, AMS Mrs Teresa Warner RN RM DMU (Obstetric & Gynaecology)
Major Sponsors
Channel 7 Telethon Trust Women and Infants Research Foundation
John Newnham
Teresa Warner
Joan A Sharpe
Luigi D’Orsogna
Jan Dickinson
WIRF Annual Report 2007 Page 20
Research Reports
Pain Relief and Anaesthesia
KEY HIGHLIGHTS
< This year we completed a large Australasian multi-centre observational study that provided
data not previously available in this country and that benchmarked well with other international data.
< Team members made presentations at research congresses in Melbourne, the USA and
Chile. Professor Paech was awarded a research grant by the Australian and New Zealand College of Anaesthetists and named the Lennard Travers Professor for 2007/2008.
< The department position of ‘Research Fellow’ has been restructured to ensure security
of ongoing funding for the next two years and the previous incumbent has enrolled in a Masters of Clinical Research postgraduate degree. Our dedicated and loyal research nurses continue to provide their quality support into their ninth year.
< Participation in the largest clinical trial ever performed in anaesthesia.
The research interests of the department are predominantly clinical, although some applied basic research is also conducted. The focus of our research is on anaesthesia and pain relief for the pregnant woman (obstetric anaesthesia and analgesia), with special interests in the application of patient-controlled epidural analgesia; the efficacy and safety of intraspinal analgesic drugs; the complications of central neural block; consumer satisfaction; and pharmacology of drugs administered during lactation. Other topics of interest generating research activities and pertinent to women having anaesthesia are acute postoperative pain management, especially the clinical application of innovative drug delivery technologies; day-care anaesthesia; and perioperative outcome, for example the prevention of postoperative nausea and vomiting. The department is fortunate in having a Research Fellow position, whose role is half-time devoted to research and half to clinical service. This position has been in place since the year 2000 and is crucial to the unit’s success. The senior registrars and specialist also assist ably. We are also blessed with two outstanding part-time research midwives, Tracy Bingham and Desiree Cavill, who have shown long-standing support and have a wealth of knowledge in our areas of interest. The unit has formed fruitful collaborations with colleagues in the Anaesthesiology and Pharmacology Unit of the School of Medicine and Pharmacology and with others in the School of Women’s and Infants’ Health. The support of the Foundation’s Biostatistics and Research Design Unit, in particular Dorota Doherty and Liz Nathan, has been vital to our activities. In recent years we have initiated and joined multi-centre research groups with interstate and overseas anaesthetists and other specialists. Our involvement in the Australian and New Zealand College of Anaesthetists Trial Group has seen participation in the largest clinical trials ever conducted by our speciality. Each year the department obtains new research grants and publishes between 5 and 10 peer-reviewed original articles in the medical literature.
As a result of continued productivity and the high quality of clinical research performed we have maintained our reputation as the leading obstetric anaesthesia research unit in Australasia.
Investigators
Professor Michael Paech DM Dr Timothy Pavy FANZCA Dr Nolan McDonnell FANZCA Dr Joel Butler FANZCA Dr Katherine Shelley FANZCA Dr Paul Kwei FANZCA Dr Roger Browning FANZCA
Dr Lloyd Green FANZCA Dr Melanie Thew FRCA Dr Magda Rhodes FANZCA Mrs Desiree Cavill RN RM Mrs Tracy Bingham RN RM
Major Sponsors
National Health and Medical Research Council, Australia The Australian and New Zealand College of Anaesthetists The Australian Society of Anaesthetists Pfizer Australia GlaxoSmithKline
Michael Paech
Timothy Pavy
Nolan McDonnell
Melanie Thew
Desiree Cavill
Tracy Bingham
WIRF Annual Report 2007 Page 21
Research Reports
Newborn Nutrition
The focus this year has been on developing and implementing earlier, more aggressive feeding regimens for preterm infants, which is seen as a necessary strategy to arresting the nutrition deficit that is accrued by preterm infants in the early days and weeks post delivery. A parenteral nutrition audit conducted in the Unit earlier this year suggested increased delivery of amino acids and glucose on day 1 of life was required to promote improved weight gain of our preterm infants. Parenteral nutrition has recently been re-formulated in the Neonatal Clinical Care Unit (NCCU) and revised parenteral feeding protocols are currently being implemented. The physiological, biochemical and nutritional efficacy of these changes will be formally audited. Human milk (mothers’ own milk and/or donor milk) is actively promoted as the optimal choice of enteral feed for all preterm infants in the NCCU. It’s fortification with extra protein, calcium, phosphorus and other micronutrients is essential to ensure the latest recommended nutrient intakes are met. The revised human milk fortification regimens which were introduced into the Unit in January 2006 have resulted in improved weight gain of preterm infants, once full enteral feeds are achieved. The composition of this weight gain however, is unknown, and is emerging as a necessary measure of the adequacy of nutrition intakes. It has been difficult until now, to easily and accurately measure the body composition of preterm infants. However, the exciting new acquisition of the ‘Pea Pod’, which utilises air displacement plethysmography technology to measure body composition, will enable the safe measurement of body composition of the infants in the Unit and will allow clinicians to more appropriately target nutrition intakes to growth needs. A pilot study is underway to obtain baseline body composition data on the preterm infants and will inform an intervention trial next year which will seek to optimise the fortification and modification of human milk feeds to promote adequate and appropriate growth. We would like to acknowledge Mr Stan Perron and the Perron Charitable Trust for generously donating the ‘PEA POD’.
Investigators
Professor Karen Simmer PhD FRACP Associate Professor Jill Sherriff PhD APD Professor Peter Hartmann BRurSc (Hons) PhD Gemma McLeod MSc APD PhD Candidate
The revised human milk fortification regimens which were introduced into the Unit in January 2006 have resulted in improved weight gain of preterm infants.
Karen Simmer
Jill Sherriff
Peter Hartmann
Gemma McLeod
WIRF Annual Report 2007 Page 22
Research Reports
Neonatal Infection
Despite the advances of perinatal care, the morbidity, mortality and financial costs of preterm delivery remain extremely high – the estimated US hospital costs of preterm births are over US$ 18 billion per year. Preterm deliveries accounts for 8% of Australian births (20,000 births per year), but preterm infants account for 75% of neonatal mortality and morbidity, much of which is associated with complications caused by infections. Preterm infants are exquisitely susceptible to life-threatening infections and up to 50% of infants born before 28 weeks develop an invasive bloodstream infection (septicaemia). Attempts to reduce the incidence of infection and related inflammatory disorders in preterm infants have been largely unsuccessful to date and the immunological basis for this heightened vulnerability remains unclear. The 20,000 Australian infants born prematurely each year are particularly susceptible to infection in the neonatal period, particularly with coagulase negative staphylococci (CoNS), which are the commonest cause of infection in neonatal intensive care units worldwide. Infection-driven inflammation also underlies other adverse neonatal outcomes, such as chronic lung disease (CLD). There is very little known about the immune responses of newborn - and particularly preterm infants - to CoNS. An understanding of the response of the preterm immune system to CoNS is essential to develop strategies that address the unique vulnerability of this population to this normally harmless bacteria. This project is investigating the early immune responses (called ‘the innate immune system’) to both CoNS and important molecules that signal to the immune system through the Toll-like receptors (TLRs). TLR signalling is critical to the initial response to infection and in directing subsequent adaptive immune responses and inflammation. The limited neonatal data, largely derived from term infants, suggest relative deficiencies in TLR responses may underlie the increased susceptibility of newborn infants to infection. The study uses samples collected from preterm and term infants and their mothers, as part of the ‘SPIN’ study (‘Study of Immune Responses in the Newborn’), which has been previously supported by WIRF. The SPIN cohort (~400 infants enrolled, or whom 300 are preterm) is a unique resource that allows us to investigate this important clinical area in considerable detail. A greater understanding of innate immune responses is therefore essential to develop specific interventions that will lead to a reduction in the burden of infections and other inflammation-mediated pathologies in this vulnerable population. This unique and innovative research will allow the development of strategies to prevent infections, reducing the huge human and economic costs that arise from serious infection in preterm infants. (Strunk T, Richmond P, Currie AJ, Simmer K, Levy O, Burgner D. Neonatal immune responses to Coagulase-negative staphylococci. Curr Opin Infec Dis 2007)
Preterm deliveries account for 8% of Australian births (20,000 births per year), but preterm infants account for 75% of neonatal mortality and morbidity, much of which is associated with complications caused by infections.
Investigators
Professor Karen Simmer PhD FRACP Dr David Burgner PhD FRACP Dr Dorota Doherty BSc (Hons) PhD Dr Tobias Strunk PhD Student Dr Andrew Currie BSc (Hons) PhD Dr Peter Richmond FRACP The project is a collaboration between WIRF, the Schools of Women’s and Infants’ Health and of Paediatrics and Child Health, UWA, and of the WA Institute of Medical Research. International collaboration and expertise is with Dr Offer from Harvard Medical School. Dr Strunk is a PhD student with UWA supported by a research fellowship from the German Research Foundation.
Karen Simmer
David Burgner
Dorota Doherty
WIRF Annual Report 2007 Page 23
Research Reports
Antidepressant Medication Use in Pregnancy
Postnatal depression is a common and serious problem to women and families. New antidepressant medication (SSRI) is very useful in the management of depressed patients and is the drug of choice for women at risk of postnatal depression. However, little is known about placental transfer of SSRI medication and lack of information has led to some professional bodies cautioning the use of SSRI medication during pregnancy and lactation. Cessation of antidepressant medication in these women at high risk of postnatal depression could have serious adverse affects on morbidity and even mortality. We have just completed a study of 60 women taking SSRI during pregnancy and matched control women to assess the amount of different SSRI drugs crossing the placenta by collecting maternal, umbilical and neonatal blood. We also assessed the affects of these drugs including withdrawal signs by performing behavioural assessments with the babies during the first week of life. The results show that despite significant placental transfer of the SSRI medication, effects on behaviour are mild. The information will re-assure new mothers that it is safe to continue their antidepressant medication and help them understand and manage the first few days of irritability that their new baby may have.
Investigators
Dr Jon Rampono MBChB BFGP FRANZCP Professor Ken Illett BPharm PhD Dr Dorota Doherty BSc (Hons) PhD Ms Yen Kok RN RM Professor Karen Simmer PhD FRACP Collaborations between The University of Western Australia, King Edward Memorial Hospital, Women and Infants Research Foundation. Funded by WIRF.
Research Reports
Neonatal Gastrointestinal Disease
Necrotising enterocolitis. (NEC) is the most common gastrointestinal emergency in preterm neonates. The incidence of this potentially disastrous illness (5%-10% of all neonates <32 weeks’ gestation) has not changed significantly despite the recent advances in neonatal intensive care. The mortality related to definite NEC continues to be around 20% -30%, approaching 50% to 100% in those with the most severe form of the disease, characterised by full thickness bowel necrosis. The need for operative intervention and mortality is significantly higher (40%-50%) in extremely low birth weight (ELBW) neonates with NEC. Significant long-term morbidity includes debilitating complications like development of intestinal stricture, recurrent bouts of catheter related sepsis, malabsorption and malnutrition related to short bowel syndrome and total parenteral nutrition -induced liver failure that may eventually require liver-small bowel transplantation in some cases. Neurodevelopmental impairment is also a major concern in preterm survivors of NEC. Our hypothesis is that an immunomodulator drug, pentoxifylline, will reduce bowel perforation and death in infants with NEC. We tested this hypothesis in a randomised blinded study in preterm rates. This study was funded by WIRF and demonstrated dramatic clinical benefits. (Travadi J, Patole S, Charles A, Doherty D, Dvorak B, Simmer K. Pentoxifylline reduces the incidence and severity of necrotising enterocolitis in a neonatal rat model. Pediatr Res 2006). We have now commenced a randomised, controlled trial in preterm neonates with NEC to assess the efficacy and safety of pentoxifylline in preventing the progression of the illness. Centres in India, Malaysia and Singapore are collaborating to recruit a large enough sample to test the hypothesis in humans.
Sanjay Patole
Karen Simmer
Investigators
Dr Sanjay Patole FRACP Dr Dorota Doherty BSc (Hons) PhD Professor Karen Simmer PhD FRACP Collaboration is between UWA, KEMH and WIRF.
Dorota Doherty
WIRF Annual Report 2007 Page 24
Research Reports
Neonatal Respiratory Medicine
KEY HIGHLIGHTS
< Commenced 1 year follow-up of infants who had lung function measurements in the newborn period. < Preliminary studies to investigate the concept of ventilator induced diaphragmatic dysfunction in the newborn lung. < Initiated project aiming to optimise ventilator settings during high-frequency jet ventilation. < Further built on our solid scientific research base in resuscitation research – investigating the impact of body temperature after
delivery on initial lung injury.
< Assessed the impact of ventilation modality on the transfer of inflammation from the lung to the rest of the body. < Developed a new technology in ventilation by gathering preliminary data required to generate variable ventilation waveforms which
aim to improve lung volume recruitment without injuring the lung.
< Continued our work investigating the impact of antenatal inflammation on airway reactivity after birth, and the potential for
treatment with antibodies that may influence the development of the immune system.
The neonatal respiratory research 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 technologies with the purpose of minimizing lung injury and finding ways to optimise the long term respiratory health and well-being of premature babies. From 2004-2006 we actively measured the growth and development of lungs in healthy newborn babies as well as those born prematurely with and without lung disease. These studies formed the basis of a Bachelor of Medical Science thesis – recently submitted by Ms Kandadai Deeptha, and are being written up for publication in collaboration with research units from London and Germany. In 2007, Dr Sven Schulzke was awarded a Telethon Fellowship to undertake follow-up lung function measurements in these infants at 1 year of age in collaboration with the Department of Respiratory Medicine at PMH. This year, Dr David Baldwin has submitted his PhD on control of breathing in newborn infants, a study undertaken in collaboration with the Institute of Child Health and the University Children’s Hospital in Berne, Switzerland. In 2007, as we shifted our focus to investigating ground-breaking concepts in neonatal mechanical ventilation, the major focus of the unit has been transferred to studies using the preterm lamb model. Dr Pillow was awarded the prestigious Sylvia Charles Viertel Senior Medical Fellowship and an NHMRC project grant to investigate the concept of Variable Ventilation in the premature newborn lung. Dr Polglase was awarded the NHMRC /Heart Foundation Postdoctoral Fellowship and is undertaking studies aiming to understand more about the factors controlling pulmonary blood flow in the preterm lung. Studies undertaken in collaboration with international colleagues and the National Institute of Health remain a significant part of the overall work undertaken by the group. In addition, our ongoing collaboration with Fisher & Paykel Healthcare and our new collaboration with Bunnell Inc have facilitated several smaller studies aiming to identify optimal ventilation strategies and newborn care procedures that may reduce lung injury and the effect of lung ventilation on other body systems.
Investigators
Dr Jane Pillow FRACP PhD (Distinction) Dr Graeme Polglase BSc(Hons) PhD Dr Ilias Nitsos BSc (Hons) PhD Dr David Baldwin MBBS BMedSc Dr Sven Schulzke MD Ms Carryn McLean BSc (Hons) Research Assistant Ms Andrea Lee BSc(Hons) PhD Candidate Ms Gabby Musk BSc BVMS Cert VA Dipl ECVAA MRCVS PhD Candidate
Jane Pillow
Graeme Polglase
Ilias Nitsos
David Baldwin
Major Sponsors
National Health and Medical Research Council, Australia Channel 7 Telethon Trust Raine Foundation, The University of Western Australia Women and Infants Research Foundation
Sven Schulzke
Carryn McLean
Andrea Lee
Gabby Musk
WIRF Annual Report 2007 Page 25
Research Reports
Flight after Preterm Birth
While air travel is a popular form of travel, there is little known about the effects and safety of air travel on infants. Aircraft cabins are pressurised to an altitude of 1500-2400m resulting in a partial pressure of oxygen of 15kPa, equivalent to an ambient oxygen level of 15-16% oxygen. Air travel may pose a risk to infants due to the low oxygen environment in aircraft cabins. A small decline in oxygen saturation has been shown in healthy adults and children over 6 months during flight, which is considered to be clinically unimportant. The British Thoracic Society’s and Canadian Paediatric Society guidelines for air travel in infants recommend that healthy term infants not undertake air travel until 1 week of age, and that expremature infants with a history of respiratory disease undergo a pre-flight 20 minute Hypoxia Challenge Test (HCT). However, while the HCT has been shown to replicate in-flight hypoxia in adults and adolescents, its accuracy has not been studied in infants. Western Australia is the largest state in Australia, with an estimated north-south length of 3000km. All tertiary neonatal care is centralised in Perth, located in the southwest corner of the state. Ex-premature infants born in Perth are transferred to their nearest hospital when they no longer require specialised care. Because of vast distances, infants are often transferred on commercial aircraft, accompanied by a nurse. This prospective observational study aimed to determine the accuracy of the hypoxia challenge test for predicting in-flight hypoxia in this population. 46 preterm infants were studied before and during flight. The results demonstrated that the standard test for children and adults (HCT) did not accurately predict in-flight hypoxia in ex-preterm neonates. The results of this study were that all ex-preterm infants flying home after neonatal intensive care should receive supplemental oxygen therapy to prevent serious compromise in flight.
Investigators
Dr Mary Sharp FRACP Dr Steven Resnick MBBCh Dr Graham Hall PhD Dr Steve Stick FRACP PhD Professor Karen Simmer PhD FRACP Collaboration is between UWA, Neonatal Clinical Care Unit King Edward Memorial Hospital, Respiratory Medicine Princess Margaret Hospital for Children and the Schools of Women’s and Infant’s Health and Paediatrics and Child Health, The University of Western Australia. Funded by WIRF.
Western Australia is the largest state in Australia. Because of vast distances, infants are often transferred on commercial aircraft, accompanied by a nurse.
Research Reports
Long Term Follow Up after Preterm Birth
Neonatal outcome research continues to make a significant contribution to the department’s research workload. Western Australia is well known for comprehensive regionally based outcome data, and led to an invited presentation in Wellington, NZ on disability outcomes for very preterm infants, as well as papers presented at the ESPR meeting in Barcelona. Dr G Holder also presented a paper at the Neonatal Summer Symposium held in Perth on the relationship between mortality and outborn delivery. The last 12 months has seen further development of a most exciting collaboration with a RPH based respiratory research team looking at lung outcomes in young adults who were born very preterm. This study has attracted NH&MRC funding and is likely to be the largest such study of preterm infants’ lung function in adult life in the published literature.
Investigators
Dr Noel French MBChB DCH FRACP Dr Dan Chambers, Royal Perth Hospital Ms Helen Benninger RN RM NNT CHN Dr Judy McMichael MBBS FRACP
WIRF Annual Report 2007 Page 26
Research Reports
Breastfeeding Research
KEY HIGHLIGHTS
< Infant feeding studies have discovered that infants causing pain during breastfeeding apply
a significantly higher pressure than those who do not cause pain.
< Techniques developed in our laboratory have attracted international researchers to study
clinical based problems.
< During the year the unit expanded to include clinical specialists: Dr Lynda Chadwick
(Paediatrician), Dr Jane Deacon and Dr Marnie Rowan (General Practitioners) to further facilitate the translation of research into clinical practice.
The Human Lactation Research Group led by Professor Peter Hartmann continues to lead international research into the synthesis, secretion and removal of breastmilk. Understanding the basic physiology of both the breast and the infant during lactation is critical to developing strategies to improve infant nutrition and health. The recent Australian Senate Report into Breastfeeding released in August 2007 further highlights the importance of this research. Studies focusing on the removal of breastmilk by both the infant and the breast pump have continued this year with further investigation into the suck-swallow-breathe reflex of breastfeeding infants. It is believed that good co-ordination of the suck-swallow- breathe reflex leads to safe and efficient feeding. Much study has been performed on preterm infants who have been bottle-fed with little investigation of the breastfed term infant population. Our laboratory has developed sophisticated techniques that enable the comprehensive assessment of the suck-swallow-breathe reflex in both term infants and infants causing persistent nipple pain. Indeed Ms Holly McClellan has found that a proportion of nipple pain can be attributed to the pressure applied to the breast by the infant rather than the inability of the mother to attach the infant to the breast correctly. This discovery will allow the development and monitoring of interventions for these mother and infant dyads. In clinical practice it is observed that both the effectiveness and efficacy of milk expression is influenced by breast shield size. Associate Professor Dr Diane Spatz from The University of Pennsylvania joined us for a sabbatical in February to begin a study investigating this phenomenon. This study is now complete and analysis is in progress. The preterm infant is very susceptible to many diseases due to the immaturity of major systems such as the respiratory and gastrointestinal system. The provision of breastmilk has been shown to reduce many infections and necrotizing endocolitis. However the abrupt termination of pregnancy causes the mammary gland to synthesise breastmilk earlier than that for term babies. This results in delay in milk production and differences in milk composition. To determine both the quantity and quality of milk from mothers who delivered prematurely, 39 women from the NICU at King Edward Memorial Hospital were intensely studied. Mr Ching Tat Lai found large variations in both the quantity and quality
Understanding the basic physiology of both the breast and the infant during lactation is critical to developing strategies to improve infant nutrition and health.
Peter Hartmann
Jill Sherriff
Donna Geddes
Naomi Trengove
Jacqueline Kent
Wei Wei Pang
Ching Tat Lai
Holly McClellan
Charles Czank
Danielle Prime
WIRF Annual Report 2007 Page 27
of milk. Currently analysis is being performed on the number of times a mother must express to provide adequate milk for her infant. Combined with data obtained from a collaborative study with Stanford University it is anticipated that this study will provide evidence-based guidelines for the expression of milk by preterm mothers. The most recent members to join the team are clinical specialists. Lactation Consultant Catherine Garbin is using her clinical skills in assessing infant feeding combined with the data collected from the suck-swallow-breathe study to identify problems and implement strategies with the aim of improving the breastfeeding relationship. General Physicians Dr Jane Deacon and Marnie Rowan are contributing a medical approach to the research. They have embarked on a study in collaboration with Clinipath to identify the incidence of Staphlococcus aureus infection in women experiencing nipple pain/trauma during breastfeeding. Last but not least the extensive experience of Paediatrican Dr Lynda Chadwick has enabled the team to begin to associate the infant studies findings with infant development and behaviour. Lynda is particularly interested in the feeding of compromised infants and those infants who display gastrointestinal symptoms such as colic and gastroesophageal reflux. The contribution of these clinical based members will enable the translation of research into clinical based practice. Professor Kieko Sakuma, Kagawa Nutrition University, Japan has recently joined the lactation group. She is interested in developing and exchange of postgraduate students between her University and the Human Lactation Research Group.
Investigators
Professor PE Hartmann BRurSc (Hons) PhD Associate Professor Jill Sherriff PhD APD Dr Donna Geddes PhD Dr Naomi Trengove PhD Dr Jacqueline Kent PhD Dr Wei Wei Pang PhD Mr Ching Tat Lai MSc Ms Holly McClellan BSc (Hon) Mr Charles Czank BSc (Hon) Ms Danielle Prime BSc (Hon) Ms Gemma McLeod MSc APD Mr Tim Whitmore BMedSci Student Mr Ibrihim Abdul BSc MSc Ms Catherine Garbin IBCLC Ms Tracey Williams BSc Dr Jane Deacon MBBS Dr Marnie Rowan MBBS Dr Lynda Chadwick MBBS FRAP (Paediatrics)
Major Sponsors
Medela AG (Switzerland) Rotary (Thornlie Br, WA) Channel 7 Telethon Trust
Gemma McLeod
Catherine Garbin
Tracey Williams
Jane Deacon
Marnie Rowan
WIRF Annual Report 2007 Page 28
WIRF Annual Report 2007 Page 29
Research Reports
The Origins of the Polycystic Ovary Syndrome
Overview Research
The Polycystic Ovary Syndrome (PCOS) affects up to 10% of women of reproductive age, which translates into around 350,000 women in Australia. It is the most common hormonal disorder in women. The syndrome has far-reaching adverse implications for general and reproductive health, including menstrual disorder, obesity, infertility, miscarriage, pregnancy complications, increased risk of diabetes and possibly heart disease. PCOS also commonly causes cosmetic problems such as excess body hair and acne. The underlying causes of PCOS are not known but are thought to arise during intrauterine (fetal) life and to be modified by aspects of childhood health, particularly overweight and obesity. However, it has not previously been possible to investigate this. Using a large and unique cohort of adolescents followed since fetal life, throughout childhood and currently aged 14-16 years (the Raine cohort) our research group is investigating for the first time the intrauterine and early childhood causes of PCOS. Understanding the causes of PCOS will lead to improvements in key areas of health for women internationally including reproductive health, diabetes and heart disease. In addition we are studying the incidence of common gynaecological problems in adolescent girls as these common complaints frequently impact upon schooling, sporting and social activities.
Preliminary Data
This project is on-going. To date 141 girls have undergone timed ultrasound scans of their ovaries and blood plasma hormonal assessment. In a subset of 349 girls we have demonstrated for the first time that both birth weight and weight gain in childhood predict age at menarche. Lower expected birth weight ratio combined with higher body mass index (BMI) at 8 years of age, predicted earlier age at menarche and this relationship existed across normal birth weight and BMI ranges.
Investigators
Professor Martha Hickey BA (Hons) MSc MB ShB MRCOG FRANZCOG MD Dr Roger Hart MD FRANZCOG MRCOG Dr Dorota Doherty BSc (Hons) PhD
Major Supporters
National Health and Medical Research Council of Australia; Project Grant The University of Western Australia Department of Health of Western Australia
The underlying causes of PCOS are not known but are thought to arise during fetal life and to be modified by aspects of childhood health, particularly overweight and obesity.
Martha Hickey
Roger Hart
Dorota Doherty
WIRF Annual Report 2007 Page 30
Research Reports
Menopausal Symptoms following Breast Cancer
RESEARCH OUTCOMES AND HIGHLIGHTS
< Development of a Menopause Information Tool for young breast cancer patients which has
recently been evaluated by 60 young breast cancer patients and will be available in printed and web-based versions for national and international use. This project has been funded by the National Breast Cancer Foundation (Concept Awards).
< Short listed for a $5 million grant by the National Breast Cancer Foundation to develop a
Centre of Excellence for young women with breast cancer based in WA.
< Awarded the “Fashion Targets Breast Cancer” prize by the National Breast Cancer Foundation. < We have been invited to present this new model of clinical care at several national and
international meetings and have published information about this service and our research results in international peer reviewed journals.
< The clinic has been acclaimed nationally and internationally as an important and innovative
new service.
< We have received excellent feedback from consumers about the service and have
established consumer support groups.
< We have developed evidence based guidelines for the management of menopausal
symptoms after cancer.
< We have developed a new clinical service (“POSSUM”) for women scheduled to undergo
surgical menopause. A menopause nurse visits these patients pre-operatively, provides information about menopause and where to get help.
< We have collaborated with industry in a number of international clinical trials of new non-
hormonal agents for menopausal symptoms.
Overview of Research
Breast cancer affects one in eleven women in Australia and is the commonest cause of death in women of middle years. Survival from breast cancer is improving and menopausal symptoms are now one of the most common and debilitating side effects of breast cancer treatments with long-lasting effects on quality of life, body image, sexuality, sexual function and self esteem. Menopausal symptoms can be so severe that a significant percentage of women stop their breast cancer treatments because of them. Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms. However, it has recently been demonstrated that HRT may increase the risk of breast cancer recurrence. As survival for breast cancer continues to improve, the number of women suffering from menopausal symptoms is likely to increase. The importance of safe and effective treatments for severe menopausal symptoms after breast cancer has become paramount. At King Edward Hospital in Western Australia we have established the world’s first menopause clinic dedicated to women with a history of cancer (MSAC: “menopausal symptoms after cancer”). So far, we have seen over 400 women, the majority of whom have a history of breast cancer and others with gynaecological and haematological cancers. We have also seen around 100 women considering surgical menopause to reduce their risk of developing ovarian, breast or uterine cancer.
Survival from breast cancer is improving and menopausal symptoms are now one of the most common and debilitating side effects of breast cancer treatments.
Investigator
Professor Martha Hickey BA (Hons) MSc MB ChB MRCOG FRANZCOG MD
Major Sponsors
National Health and Medical Research Council, Australia National Breast Cancer Foundation The University of Western Australia Department of Health of Western Australia
Martha Hickey
WIRF Annual Report 2007 Page 31
Research Reports
Midwifery
RESEARCH OUTCOMES AND HIGHLIGHTS
< Preliminary findings demonstrate that breastfeeding is highly valued with women stating
that they felt well supported by their partners in their decision to breastfeed.
< In the early weeks following discharge, some mothers reported struggling with the
unpredictability of the infant’s sleeping and feeding patterns, and lack of routine that contrasted with their hospital experience and expectations.
Feeding and Sleeping Outcomes of Neonatal Intensive Care Unit Graduates and Healthy Term Infants
The study aims to describe and compare maternal breastfeeding confidence and satisfaction, feeding practices, and women’s perceptions of infant sleeping and settling behaviours for a cohort of women with sick/preterm infants that required NICU care, and a cohort of women with healthy term infants across the first nine months of life. This longitudinal study replicates, in part, research being undertaken at the Royal Children’s Hospital in Melbourne. One hundred women with term, healthy infants and 100 women whose infants required nursery care have been recruited from the postnatal wards at King Edward Memorial Hospital (KEMH) and the Neonatology Clinical Care Unit nurseries. Demographic data, infant clinical data, breastfeeding background data and maternal breastfeeding confidence levels were collected on recruitment to the study. Telephone interviews were used to collect subsequent data on the infant’s settling and sleeping patterns, feeding method and maternal confidence in breastfeeding. This information is collected at five time points within the first nine months following discharge home (ie. 2 weeks, 6 weeks, 3 months, 6 months and 9 months). Women who wean before 9 months complete an evaluation of their breastfeeding experience. Data collection is due to be completed in February 2008. On discharge home from hospital, the women’s average intended duration of breastfeeding was 12 months. However, 30% weaned by 6 weeks and 40% had weaned by 12 weeks following discharge home. The most commonly cited reason for weaning was “low milk supply.” Field note data suggest that there was a wide range of responses to perceived low milk supply, ranging from replacing breastfeeds or breastmilk with artificial feeds, to seeking professional assistance, and commencing regular breast expression in an effort to increase supply. It is possible that inadequate knowledge, and / or difficulty in accessing lactation and breastfeeding information and support may have contributed to the high rate of weaning. There is a need to determine what specific forms of support and breastfeeding information would assist families to achieve their goal of breastfeeding for around 12 months. Future statistical analysis will help us to determine the impact of maternal breastfeeding self-efficacy or confidence on breastfeeding duration.
The study aims to describe and compare maternal breastfeeding confidence and satisfaction, feeding practices, and women’s perceptions of infant sleeping and settling behaviours for a cohort of women with sick/preterm infants that required NICU care, and a cohort of women with healthy term infants across the first nine months of life.
Investigators
Sharon Zuiderduyn MSc Associate Professor Jennifer Fenwick PhD Elizabeth Nathan BSc Linda Johnston PhD
Acknowledgments
Thank you to all the women who so generously gave of their time to participate in this study. Similarly we would like to thank Ms Julie Williams for managing the project so competently and Ms Sandra Andersen for her dedication to recruitment.
Major Sponsors
Women and Infants Research Foundation The Western Australian Nurses Memorial Charitable Trust.
Jennifer Fenwick
Elizabeth Nathan
WIRF Annual Report 2007 Page 32
Research Reports
Substance Use in Pregnancy
RESEARCH OUTCOMES AND HIGHLIGHTS
< We have shown that groups of illicit drug using women and non-injecting drug using
women were different in terms of education, disease of the liver (hepatitis C), inter-uterine growth restriction, precipitate delivery, smoking and gestational age at delivery.
< The infants were different in terms of birthweight, admissions to the neonatal intensive
care unit, hypoglycaemia, weight loss, and length of stay in hospital.
< Illicit drug using women were younger and more likely than non-illicit drug using women
to have adverse outcomes.
< The babies of illicit drug women were more likely than non-illicit drug using women to
have increased risk of poorer outcomes.
Approximately 80-90% of women using illicit drugs are of reproductive age. As many as 15% of women presenting for their first antenatal visit have exposed their fetus to some form of licit or illicit psychoactive drugs. The main drugs used in Australia include alcohol, opioids (heroin), cannabis, amphetamines, hallucinogens, ecstasy, and to a lesser extent, cocaine. A variety of adverse pregnancy outcomes are associated with the use of illicit drugs including blood borne viruses (hepatitis B, C, HIV) and sexually transmitted diseases in the mother, and prematurity, low birth weight, still births, neonatal withdrawal symptoms, and developmental problems in the infant. The prevalence of Hepatitis C (HCV) in injecting drug users has been estimated at 65%. Alcohol use during pregnancy can result in Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Syndrome Defects (FASD). Amphetamines are central nervous system stimulants and produce a range of dose dependent effects including anxiety, restlessness aggression, hallucinations, and in some cases psychosis. The pattern of use is commonly polydrug.
Illicit versus non-illicit drug exposure: obstetric and perinatal outcomes
During 2000-2001 two randomised controlled trials were conducted at King Edward Memorial Hospital. One study included only illicit drug using women; the other included only non-illicit drug users. Data collection for both studies was similar. Illicit drug using women were recruited at the Antenatal Chemical Dependency Clinic at King Edward Memorial Hospital around 35 weeks gestation. The drugs used were heroin, other opiates, amphetamines, cannabis, benzodiazepines, alcohol and tobacco. Small-for-Gestational-Age (SGA) was defined as the expected birthweight ratio for specific gestational age, sex and parity. Tobacco appeared to be the main factor associated with SGA and is dose dependent. Heroin use in late pregnancy is associated with a higher risk of delivering a SGA baby. This provided a rare opportunity to examine obstetric and neonatal outcomes within the same spatial and temporal context. It has increased our knowledge of the outcomes of illicit drug using mothers and their infants.
Approximately 80-90% of women using illicit drugs are of reproductive age.
Investigators
Professor Anne Bartu PhD FRCNA Dr Dale Hamilton FRANZCOG Dr Dorota Doherty BSc (Hons) PhD Dr Jennifer Henderson BSc RM MPH Professor Susan McDonald RN RM CHN BAppSc PhD FACMI Dr Joanne Ludlow FRANZCOG Ms Jenny Sharp BHSc (Nurs) RN RM MRCNA
Anne Bartu
Dale Hamilton
Dorota Doherty
Jennifer Henderson
WIRF Annual Report 2007 Page 33
Research Reports
Teenage Pregnancy Intention, Contraceptive Use and Repeat Pregnancy
RESEARCH OUTCOMES AND HIGHLIGHTS
< Analysis of the baseline questionnaire and postnatal six week and three month
questionnaires has been completed. In addition an audit of the medical records of the study participants has also been completed.
< Median age at recruitment was 17 years, with 12 years the youngest. < The majority 75% reported that they did not intend to become pregnant, however
73% reported not using contraception or using contraception inconsistently at the time of conception.
< The majority of teenagers (65%) smoked prior to pregnancy with 87% smoking more than
10 cigarettes a week. Most teenagers (74%) also used alcohol before they fell pregnant with 61% drinking more than 4 drinks on each occasion. In addition most teenagers (70%) used Marijuana before pregnancy with 42% using it once a week or more.
< Contraceptive use was boosted up to 3 months, by the home visiting midwife and the one
follow-up clinic visit.
< By 12 months, contraceptive use had fallen with 22% of participants who had reached 12
months postpartum experiencing a rapid repeat pregnancy.
Australia has one of the highest teenage pregnancy rates in the Western world and a relatively high teenage birth rate. Teenage mothers and their children are at greater risk of poor physical, emotional, educational and social outcomes than the general population. Adolescent mothers have a particularly high rate of repeat pregnancy and poorer outcomes are further compounded for this group. Effective contraceptive use is an important goal in delaying repeat pregnancy in young teenage mothers. However, the reliable use of the oral contraceptive pill can be problematic for some of these teenagers. This study aims to determine whether Etonogestrel implantable contraceptive (Implanon) is acceptable to this group of teenagers and can reduce repeat unwanted pregnancy. 70% of pregnant teenagers attending the King Edward Memorial Hospital Adolescent Clinic were recruited and are currently being followed over a two year period, with 46% of the participants electing to use Implanon for contraception. Participants were asked to complete a confidential baseline questionnaire, containing standardized measures of pregnancy intention, sexual activity and contraceptive use, during the mid antenatal period and then at three monthly intervals until their child is two years old.
Australia has one of the highest teenage pregnancy rates in the Western world and a relatively high teenage birth rate.
Investigators
Dr Rachel Skinner PhD Professor Martha Hickey MD FRANZCOG Dr Dorota Doherty BSc (Hons) PhD
Project Staff
Lucy Lewis RM PhD Candidate
Rachel Skinner
Martha Hickey
Dorota Doherty
Lucy Lewis
WIRF Annual Report 2007 Page 34
Publications
2007
Bartu A, McDonald S, Doherty DA, Ludlow JP, Sharp J, Henderson J. Illicit versus non-illicit drug exposure: Obstetric and perinatal outcomes. Journal of Paediatrics and Child Health (2007); 43(1):A61. Cregan MD, Fan Y, Appelbee A, Brown ML, Klopcic B, Koppen J, Mitoulas LR, Piper KM, Choolani MA, Chong YS, Hartmann PE. Identification of nestin-positive putative mammary stem cells in human breastmilk. Cell Tissue Res (2007); 329(1):129-36. Doherty DA, Hamilton D, Bartu A, Ludlow JP. Illicit drug use in pregnancy and delivery of a small for gestational age infant: are they related? Journal of Paediatrics and Child Health (2007); 43(1):A61. Hart R, Karthigasu K, Garry R. Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG (2007); 114(5):656. Huang RC, Burke V, Newnham JP, Stanley FJ, Kendall GE, Landau LI, Oddy WH, Blake KV, Palmer LJ, Beilin LJ. Perinatal and childhood origins of cardiovascular disease. Int J Obes (2007); 31(2):236-44. Jacobs LA, Dickinson JE, Hart PD, Doherty DA, Faulkner SJ. Normal nipple position in term infants measured on breastfeeding ultrasound. J Hum Lact (2007); 23(1):52-9. Knight BS, Pennell CE, Adamson SL, Lye SJ. The impact of murine strain and sex on postnatal development after maternal dietary restriction during pregnancy. J Physiol (2007); 581(Pt 2):873-81. Knight BS, Pennell CE, Shah R, Lye SJ. Strain differences in the impact of dietary restriction on fetal growth and pregnancy in mice. Reprod Sci (2007); 14(1):81-90. Lynch AM, Goodman C, Choy PL, Dawson B, Newnham JP, McDonald S, Blanksby BA. Maternal physiological responses to swimming training during the second trimester of pregnancy.Res Sports Med (2007); 15(1):33-45. Magann EF, Doherty DA, Ennen CS, Chauhan SP, Shields D, Gjesdal SM, Morrison JC. The ultrasound estimation of amniotic fluid volume in diamniotic twin pregnancies and prediction of peripartum outcomes. Am J Obstet Gynecol (2007);196(6):570.e1-6. Magann EF, Doherty DA, Turner K, Lanneau GS Jr, Morrison JC, Newnham JP. Second trimester placental location as a predictor of an adverse pregnancy outcome. J Perinatol (2007); 27(1):9-14. O'Leary CM, de Klerk N, Keogh J, Pennell C, de Groot J, York L, Mulroy S, Stanley FJ. Trends in mode of delivery during 1984-2003: can they be explained by pregnancy and delivery complications? BJOG (2007); 114(7):855-64. Paech MJ, Rucklidge MW, Lain J, Dodd PH, Bennett EJ, Doherty DA. Ondansetron and dexamethasone dose combinations for prophylaxis against postoperative nausea and vomiting. Anesth Analg (2007); 104(4):808-14. Patole SK, Kumaran V, Travadi JN, Brooks JM, Doherty DA. Does patent ductus arteriosus affect feed tolerance in preterm neonates? Arch Dis Child Fetal Neonatal Ed (2007); 92(1):F53-5. Pennell CE, Jacobsson B, Williams SM, Buus RM, Muglia LJ, Dolan SM, Morken NH, Ozcelik H, Lye SJ; PREBIC Genetics Working Group, Relton C. Genetic epidemiologic studies of preterm birth: guidelines for research. Am J Obstet Gynecol (2007); 196(2):107-18. Sloboda DM, Hart R, Doherty DA, Pennell CE, Hickey M. Age at menarche: Influences of prenatal and postnatal growth. J Clin Endocrinol Metab (2007); 92(1):46-50. Sloboda DM, Moss TJ, Li S, Doherty D, Nitsos I, Challis JR, Newnham JP. Prenatal betamethasone exposure results in pituitary-adrenal hyporesponsiveness in adult sheep. Am J Physiol Endocrinol Metab (2007); 292(1):E61-70. Wang LP, McLoughlin P, Paech MJ, Kurowski I, Brandon EL. Low and moderate remifentanil infusion rates do not alter target controlled infusion propofol concentrations necessary to maintain anesthesia as assessed by bispectral index monitoring. Anesth Analg (2007); 104:325-331.
2006
Baldwin DN, Pillow JJ, Stocks J and Frey U. Lung-Function Tests in Neonates and Infants With Chronic Lung Disease: Tidal Breathing and Respiratory Control, Pediatric Pulmonology (2006); 41:391-419. Bartu A, Sharp J, Ludlow J, Doherty DA. Postnatal home visiting for illicit drug-using mothers and their infants: a randomised controlled trial. Aust N Z J Obstet Gynaecol (2006); 46(5):419-26. Braun T, Li S, Moss TJ, Newnham JP, Challis JRG and Sloboda DM. Differential effects of maternal betamethasone on ovine placental lactogen and binucleate cell number in sheep placentome subtypes, 4th World Congress on Developmental Origins of Health and Disease (DOHaD) (2006); 82:542. Braun T, Li S, Sloboda DM, Moss TJM, Newnham JP and Challis JRG. Influences of early maternal dexamethasone on fetal growth in sheep, 4th World Congress on Developmental Origins of Health and Disease (DOHaD) (2006); 82:543. Burgner D, Jamieson SE, Blackwell JM. Genetic susceptibility to infectious diseases: big is beautiful, but will bigger be even better? Lancet Infect Dis (2006); 6(10):653-63. Chauhan SP, Berghella V, Sanderson M, Magann EF and Morrison JC. American College of Obstetricians and Gynecologists practice bullentins: An overview, American Journal of Obstetrics and Gynecology (2006); 194:1564-1575. Chauhan SP, Cole J, Sanderson M, Magann EF and Scardo JA. Suspicion of intrauterine growth restriction: Use of abdominal circumference alone or estimated fetal weight below 10%, The Journal of Maternal-Fetal and Neonatal Medicine (2006); 19:9,557-562. Dickinson JE, Keil AD and Charles AK. Discordant Fetal Infection for Parvovirus B19 in a Dichorionic Twin Pregnancy, Twin Research and Human Genetics (2006) 9:3,456-459. Doherty DA, Magann EF, Francis J, Morrison JC, Newnham JP. Pre-pregnancy body mass index and pregnancy outcomes. Int J Gynaecol Obstet (2006); 95(3):242-7.
WIRF Annual Report 2007 Page 35
Fatovich D, Jacobs IG, Celanza A, Paech MJ. An observational study of bispectral index monitoring for out of hospital cardiac arrest. Resuscitation (2006); 69:207-212. Ferguson EA, Paech MJ, Veltman MG. Hypertrophic cardiomyopathy and caesarean section: intraoperative use of transthoracic echocardiography. Int J Obstet Anesth (2006); 15;311-6. Fetherston CM, Lai CT, Hartmann PE. Relationships between symptoms and changes in breast physiology during lactation mastitis.Breastfeed Med (2006); 1(3):136-45. Fetherston CM, Lai CT, Mitoulas LR, Hartmann PE. Excretion of lactose in urine as a measure of increased permeability of the lactating breast during inflammation. Acta Obstet Gynecol Scand (2006); 85(1):20-5. Gappa M, Pillow JJ, Allen J, Mayer O and Stocks J. Lung function tests in neonates and infants with chronic lung disease: lung and chest-wall mechanics, Pediatric Pulmonology (2006); 41:291-317. Hackett LP, Ilett KF, Rampono J, Kristensen JH and Kohan R. Transfer of reboxetine into breastmilk, its plasma concentrations and lack of adverse effects in the breastfed infant, European Journal of Clinical Pharmacology (2006); 62:633-638. Hadlow NC, Hewitt BG, Dickinson JE, Jacoby P and Bower C. Community-based screening for Down syndrome in the first trimester using ultrasound and maternal serum biochemistry, British Journal of Obstetrics and Gynecology (2006); 113(3):363-364. Hart R, Sloboda DM, Doherty D, Pennell C, Norman R, Franks S and Hickey M. The Effect of Growth and Intrauterinei Exposure to Maternal Androgens on Reproductive Function in a Cohort of Australian Adolescents - Preliminary Findings, The Fertility Society of Australia, 25th Annual Scientific Meeting (2006); 46:A11. Hart R, Doherty DA, Karthigasu K and Garry R. The value of virtual reality-simulator training in the development of laparoscopic surgical skills, Journal of Minimally Invasive Gynecology (2006); 13:126-133. Hickey M, Krikun G, Kodaman P, Frederick S, Carati C and Lockwood CJ. Long-Term Progestin-Only Contraceptives Result in Reduced Endometrial Blood Flow and Oxidative Stress, The Journal of Clinical Endocrinology and Metabolism (2006); 91(9):3633-3638. Hickey M, Crewe J, Mahoney LA, Doherty DA, Fraser IS and Salamonsen LA. Mechanisms of Irregular Bleeding with Hormone Therapy: The Role of Matrix Metalloproteinases and Their Tissue Inhibitors, The Journal of Clinical Endocrinology and Metabolism (2006); 91(8):3189-3198. Hillman N, Moss T, Polglase G, Pillow JJ, Kallapur S and Jobe AH. Fetal resuscitation with large tidal volume causes injury similar to ventilated lambs, Pediatric Academic Societies' Annual Meeting, American Pediatric Society (2006); 59:EPAS2006:4132.1. Hülskamp G, Pillow JJ, Dinger J and Stocks J. Lung Function Tests in Neonates and Infants With Chronic Lung Disease of Infancy: Functional Residual Capacity, Pediatric Pulmonology (2006); 41:1-22.
Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics (2006); 117(3):e387-95. Knight B, Pennell C, Adamson L and Lye S. Genetic contributions of maternal dietary restriction on the development of the metabolic disorder, Society for Gynecologic Investigation 53rd Annual Meeting (2006); 13:183A. Knight B, Sunn N, Pennell C, Adamson L and Lye S. The Impact of Maternal Dietary Restriction on Offspring Cardiovascular Function in a Genetic Murine Model, Society for Gynecologic Investigation 53rd Annual Meeting (2006); 13:95A. Magann EF, Doherty DA, Briery CM, Niederhauser A, Morrison JC. Timing of placental delivery to prevent post-partum haemorrhage: lessons learned from an abandoned randomised clinical trial. Aust N Z J Obstet Gynaecol (2006); 46(6):549-51. Mizuno K, Aizawa M, Saito S, Kani K, Tanaka S, Kawamura H, Hartmann PE, Doherty D. Analysis of feeding behavior with direct linear transformation. Early Hum Dev (2006); 82(3):199-204. Moss TJM, Knox CL, Nitsos I, Polglase GR, Ikegami M, Jobe AH and Newnham JP. Amniotic Fluid Ureaplasma Colonization Induces Preterm Lung Maturation, Regardlessof Exposure to Antenatal Corticosteroids, Society for Gynecologic Investigation 53rd Annual Meeting (2006); 13:335A. Moss TJM. Respiratory consequences of preterm birth, Australian Physiological Society Symposium (2006); 33: 280-284. Nitsos I, Rees SM, Duncan J, Kramer BW, Harding R, Newnham JP, Moss TJ. Chronic exposure to intra-amniotic lipopolysaccharide affects the ovine fetal brain. J Soc Gynecol Investig (2006); 13(4):239-47. Orlikowski CE, Dickinson JE, Paech MJ, McDonald SJ, Nathan E. Intrapartum analgesia and its association with post-partum back pain and headache in nulliparous women. Aust N Z J Obstet Gynaecol (2006); 46(5):395-401. Paech M, Whybrow T. Evidence based therapies for postoperative nausea and vomiting. Asean J Anaesthesiology (2006); 7:34-44. Paech MJ, Magann EF, Doherty DA, Verity LJ, Newnham JP. Does magnesium sulfate reduce the short- and long-term requirements for pain relief after caesarean delivery? A doubleblind placebo-controlled trial. Am J Obstet Gynecol (2006); 194(6):1596-603. Page-Sharp M, Kristensen JH, Hackett LP, Beran RG, Rampono J, Hale TW, Kohan R and Ilett KF. Transfer of Lamotrigine Into Breast Milk, The Annals of Pharmacotherapy (2006); 40:1470-1471. Pennell CE, Jacobsson B, Williams SM, Buus RM, Muglia LJ, Dolan SM, Morken NH, Ozcelik H, Lye SJ, Prebic Genetics Working Group, Relton C. Genetic epidemiological studies of preterm birth: Guidelines for research. Am J Obstet Gynecol (2007); 196(2):107-1018. Pennell CE, Oldenhof AO, Perkins JE, Dunk CE, Keunen J, Tan P, Bocking AD and Lye SJ. Identification of a gene expression signature in leukocytes that predicts preterm delivery in women with threatened preterm labour, Society for Gynecologic Investigation 53rd Annual Meeting (2006); 13:175A.
WIRF Annual Report 2007 Page 36
Publications Continued...
Pillow JJ, Frerichs I and Stocks J. Lung Function Tests in Neonates and Infants With Chronic Lung Disease: Global and Regional Ventilation Inhomogeneity, Pediatric Pulmonology (2006); 41:105-121. Pillow JJ, Hillman N, Moss TJM, Polglase G, Prime N, Beaumont C, Ikegami M and Jobe AH. Physiological Advantage of Bubble Versus Ventilator-Derived CPAP, Pediatric Academic Societies Annual Meeting, USA, American Pediatric Society (2006); 59:E-PAS2006:2635.5. Polglase GR, Wallace MJ, Morgan DL, Hooper SB. Increases in lung expansion alter pulmonary hemodynamics in fetal sheep. J Appl Physiol (2006); 101(1):273-82. Polglase GR, Wallace MJ, Morgan DL and Hooper SB. Increases in lung expansion after pulmonary hemodynamics in fetal sheep, Journal of Applied Physiology (2006); 101:273-282. Rampono J, Hackett LP, Kristensen JH, Kohan R, Page-Sharp M and Ilett KF. Transfer of escitalopram and its metabolite demethylescitalopram into breastmilk, British Journal of Clinical Pharmacology (2006); 62:3,316-322. Ramsay DT, Mitoulas LR, Kent JC, Cregan MD, Doherty DA, Larsson M, Hartmann PE. Milk flow rates can be used to identify and investigate milk ejection in women expressing breast milk using an electric breast pump. Breastfeed Med (2006);1(1):14-23. Schibler A and Pillow JJ. Clinically relevant early functional and diagnostic markers of lung disease in the paediatric intensive care unit, Respiratory Diseases in Infants and Children, ed Frey U, Gerritsen J, European Respiratory Society Journals Ltd (2006); 7:142-152. Shub A, Swain JR, Newnham IA, Doherty DA, Charles AK and Newnham JP. Maternal periodontal disease is associated with inflammation in umbilical arterial blood and is predicted by maternal symptoms, Society for Gynecologic Investigation 53rd Annual Meeting (2006); 3:176A. Shub A, Swain JR and Newnham JP. Periodontal disease and adverse pregnancy outcomes, The Journal of Maternal-Fetal and Neonatal Medicine (2006); 19:9,521-528. Sloboda DM, Li S, Moss TJM, Matthews SG, Challis JR and Newnham JP. Developmental changes in hippocampal corticosteroid receptors and 11�hydroxysteroid dehydrogenase in fetal sheep: effectsof glucocorticoid exposure, 4th World Congress of Developmental Origins of Health and Disease (DOHaD) (2006); 82:545. Sloboda DM, Moss TJM, Matthews SG, Challis JR and Newnham JP. Hippocamal gene expression is altered in adult sheep offspring after prenatal betamethasone exposure, 4th World Congress on the Developmental Origins of Health and Disease (2006); 82:545-546. Sloboda DM, Newnham JP, Moss TJ and Challis JRG. The fetal hypothalamic-pituitary-adrenal axis: relevance to developmental origins of health and disease, Develomental Origins of Health and Disease, ed Gluckman P, Hanson M, Cambridge University Press (2006);191-205. Sosenko IR, Kallapur SG, Nitsos I, Moss TJ, Newnham JP, Ikegami M, Jobe AH. IL-1alpha causes lung inflammation and maturation by direct effects on preterm fetal lamb lungs. Pediatr Res (2006); 60(3):294-8. Srinivasjois RM, Nathan EA, Doherty DA, Patole SK. Renal impairment associated with indomethacin treatment for patent ductus arteriosus in extremely preterm neonates--is postnatal age at start of treatment important? J Matern Fetal Neonatal Med (2006); 19(12):793-9. Strunk T, Burgner D. Genetic susceptibility to neonatal infection. Curr Opin Infect Dis (2006); 19(3):259-63. Thorsten B, Connor K, Li S, Moss TJM, Newnham JP, Challis JRG and Sloboda DM. Prenatal exposure to betamethasone modifies adrenal steroidogenic enzyme P450C expression levels in sheep offspring, Society for Gynecologic Investigation 53rd Annual Meeting (2006); 13:94A. Travadi J, Simmer K, Ramsay J, Doherty D, Hagan R. Patent ductus arteriosus in extremely preterm infants receiving phototherapy: does shielding the chest make a difference? A randomized, controlled trial. Acta Paediatr (2006); 95(11):1418-23. Travadi J, Patole S, Charles A, Dvorak B, Doherty D, Simmer K. Pentoxifylline reduces the incidence and severity of necrotizing enterocolitis in a neonatal rat model. Pediatr Res (2006); 60(2):185-9. Wallace MJ, Thiel AM, Lines AM, Polglase GR, Sozo F, Hooper SB. Role of platelet-derived growth factor-B, vascular endothelial growth factor, insulin-like growth factor-II, mitogen-activated protein kinase and transforming growth factor-beta1 in expansion-induced lung growth in fetal sheep. Reprod Fertil Dev (2006); 18(6):655-65.
WIRF Annual Report 2007 Page 37
WIRF Annual Report 2007 Page 38
Our Heartfelt Thanks Major Supporters
The Foundation is proud to acknowledge and thank our major supporters who provide vital support to our research programs.
Telethon
Telethon has been sponsoring two fellowship positions with the Women and Infants Research Foundation since 2003. The two fellowships are for the Telethon Fetal Medicine Fellow and the Telethon Newborn Medicine Fellow. The Telethon Fellowship funds support two outstanding medical researchers. The two Fellows are provided with the resources and opportunities to conduct high level research in issues relevant to the infants of Western Australia. This unique program allows the Women and Infants Research Foundation to develop the next generation of leaders who are vital for the future of these critical fields of healthcare in our State. The Telethon Fetal Medicine Fellow position was awarded to Dr Antonia Shand who is involved in research into the prevention of preterm birth. The Telethon Newborn Medicine Fellow position was awarded to Dr Ben Hartmann, a Postdoctoral Scientist. Dr Hartmann is predominantly involved in the establishment and operation of the human milk bank, named Perron Rotary Express Milk Bank. The main beneficiary of the donated pasteurised human milk will be the very premature babies born at King Edward Memorial Hospital. Infants fed breast milk typically have lower rates of infection, less obesity and higher intelligence.
Jeff Newman and John Newnham
In 2007 the Channel 7 Telethon Trust sponsored an exciting new program known as The Fetal Future Program. This program involves the finding and evaluation of children of various ages who have previously undergone complex treatment before birth. Typically, women receive treatment for their unborn child, give birth (usually at KEMH), and then return to their community with no formal follow-up to ascertain the ongoing consequences of the fetal disease and its treatment. Government databases with computer linkages do not contain the outcomes necessary for such a follow-up program. With the support of Telethon we are able for the first time to develop the first stage in a follow-up program. We plan to follow-up children who have received prenatal treatment within the context of a specific hypothesis.
Bill Rayner and John Newnham
Chris Wharton, Dorota Doherty, Rudi Gracias, Antonia Shand, Bill Rayner, John Newnham
WIRF Annual Report 2007 Page 39
‘Pea Pod’ donated by the Stan Perron Charitable Trust
Andrew and Nicola Forrest
The Forrest family has descended from a distinguished list of prominent Western Australians acclaimed for pioneering the early development of this State. This pioneering tradition lives on through Andrew and Nicola Forrest in the context of the modern mining industry. It has been their wish to support advancement through research in fetal medicine which represents a pioneering edge of contemporary science, with a promise to improve the lives of people through interventions at early times in life. Andrew and Nicola Forrest are behind the Forrest Fellowship that has provided financial support for two research fellows at King Edward Memorial Hospital over the past five years. The Forrest Fellowship is making it possible for scientists to pioneer new fields of research. Dr Craig Pennell has been the Forrest Fellow in Maternal Fetal Medicine. His thesis studied the role of lactic acid in the monitoring of fetal well-being during labour. This study involved both ovine and human projects investigating the ability of lactic acid measurement to predict oxygen free radical activity in the brain during intrapartum asphyxia, neuro-pathological changes after asphyxia and neonatal complications. The study also addressed the role of both lactic acid and the current fetal monitoring techniques in pregnancies complicated by fetal growth restriction. Dr Deborah Sloboda (PhD) is a fetal endocrinologist who trained at the University of Toronto, Canada and has been a Postdoctoral Research Fellow within the School. Dr Sloboda has also been the Forrest Fetal Research Scientist and Head of the UWA / WIRF Research Laboratories. Dr Sloboda is investigating the developmental origins of health and disease centred around the effects of prenatal glucocorticoid treatment on fetal and postnatal hypothalamic-pituitary-adrenal function and metabolic regulation. These studies are carried out in collaboration with the Department of Physiology, University of Toronto.
The Stan Perron Charitable Trust
The Stan Perron Charitable Trust in conjunction with Rotary has provided funds to the Women and Infants Research Foundation for the establishment of the first modern human milk bank in Australia. The funds donated have enabled the purchase of specialised equipment needed for the safe processing of human milk. The human milk bank, now named the Perron Rotary Express Milk Bank (PREM Bank), aims to optimise the nourishment of Western Australian preterm and ill infants who require more breast milk than their mothers can provide. In 2007 the Trust also donated the ‘Pea Pod’ used to measure the body composition of preterm babies.
Lions
Lions have been fundamental in their support of the Women and Infants Research Foundation / UWA Laboratories since 2000. The donations received from Lions have enabled the Foundation to establish a world class molecular biology research laboratory based at King Edward Memorial Hospital for Women. Support from Lions has also allowed the Foundation to purchase laboratory equipment which has enabled us to apply for National and International grants which then amplifies every dollar received from Lions many fold. Lions has also funded the establishment of an Image Analysis Suite. This facility is primarily devoted to the microscopic analysis of tissue sections.
Rotary Clubs of Belmont and Thornlie
Rotary has provided funds to the Women and Infants Research Foundation for the establishment of the first modern human milk bank in Australia. The PREM Bank screens milk donors, then collects and stores milk which is pasteurised and made available to preterm and ill very low birth weight babies. In the first year of operation the PREM Bank has screened 60 mothers who donated 144 litres of milk. Using the Pasteuriser donated by Rotary, pasteurised human donor milk was given to 67 of KEMH’s most premature or critically ill infants.
WIRF Annual Report 2007 Page 40
HEADINGS Thank you
Thank you to Donors
We are very grateful to all of the individuals, companies and organisations that have helped to provide a strong financial base for the Foundation’s research, some of whom are listed below: Allgrove, Catherine Balfour, Yatiha Banfield, Kathleen, Estate of the Late Bower, Caroline Bunnell Inspired Infant Care Burnaby, Valerie Burns, Andrea Camins, R Cannavo, Giovanna Carrington-Jones, Ann Chang, Annie Channel 7 Telethon Trust Cimetta, Barbara Cohen, Dr Bertram, Estate of the Late Collins, Robyn Corfe, Penelope Cumming Foundation Cunningham, Carolyn Farrington, Kim Forrest, A & N French, Noel Good, Alan Hall, Jourdee Hammer, Amy Haris, Faamama Hartmann, Peter Hawkins, Peter Hunting, David Hutchinson, Maureen Isherwood, Karen Jarvis, Tracey Kaitse, Kelley Karczub, Anne Kingsbury, N & R Leucadia Foundation Lions Club of Floreat Love, Charmaine Maiolo, David & Jackie Major, Gerald Maslin, Jack Murdoch, Marjorie Newnham, John NIC Christmas Fund Ognenis, Anna Paech, Michael Payne, Anne Pennell, Craig Powell, Rebecca Pring, Valerie Purchase, John & Margaret Roche, Jody Roncio, Tina Rotary Clubs, Belmont & Thornlie Schofield, Lynette Shukralla, Heidi Simmer, Karen Smith, Brad StateWest Credit Society Steinberg Charitable Trust Sutherland, Katherine Swan Bell Tower, Chimes for Charity Team Terribile, G The Stan Perron Charitable Trust Van Eer, Maria WA Police Academy Williams, Raelene
Thank you to Volunteers
The Foundation values the generosity and skills of our volunteers. Much of our research is made possible through the funds raised by our volunteers. Volunteers in our Café and Gift Shop ensure that we remain highly profitable. Our office and marketing volunteers assist in the Development team offices. A big thank you goes to all the volunteers who joined us in the following years:
1999
Julia Allen Jill Berecry Raie Bradshaw Janice Braekevelt Kate Campbell Margaret Cooper Maria Crawford Gay Cruikshank Norma Garbin Freda Gunzburg Diane Hoffman Jill Hunt Annette Lazberger Deborah Livesey Gaile Martyn Delphine Moore Betty Redmond Jan Schofield Marie Smith Isobel Sprivulis Julie Wilson Osra Wisbey
2002
Sylvia Webster
2003
Gillian Ball Elizabeth Hyde Pam Imms Rema Starina Joy Tillett Shirley White
2004
Ann Carrington-Jones Corinne Kilbee Patricia McInnes
2005
Fay Bannister Loretta Connery Anne McAnearney Anne Montague Pam Sulc Amanda Taylor
2006
Flora Amiel Helen Arcus Meredith Cziesche Beattie Ramel Miki Soon Sandra Tan Jan Winn
2000
Beverley Boyd Ruth Cohen Win Froude Maria Gapper Luba Klein Beryl Lawler Leah McVeigh Marlene Napper
2007
Sonje Bernardini Laura Felton June Fox Elaine Horton Tamao Matsumoto Robin Simon
2001 For further information about donating to the Foundation, including the Foundation in your Will or other gifting opportunities please contact us on; Telephone: (08) 9340 1437 Email: psutherland@meddent.uwa.edu.au www.wirf.com.au
Judith Carrington Maggie Cooper Suzanne Draper Judy Earnshaw Nina Leahy Kay Lodge Yvonne Neurauter Helen Roatch Helen Robertson
WIRF Annual Report 2007 Page 41
HEADINGS
WIRF Annual Report 2007 Page 42
Research Support
External Research Grants Affiliated with the Women and Infants Research Foundation
The Women & Infants Research Foundation provides the infrastructure and funding to allow our researchers to successfully compete for external grants from organisations such as the National Health & Medical Research Council. Following is a list of competitive grants supported during the current financial year:
National Health & Medical Research Council (NHMRC) (AUSTRALIA)
• Prevention of Preterm Birth by Treatment of Periodontal Disease During Pregnancy Investigators: J Newnham, D Doherty ,J McGeachie (2005-2008 $894,750) • The Fetal and Early Childhood Origins of PCOS: A Prospective Cohort Study Principal Investigator: M Hickey (2006-2008 $487,550) • Clinical Career Development Award T Moss (2004-2008 $520,000) • Clinical Career Development Award J Pillow (2006-2010 $305,375) • Clinical Career Development Award M Hickey (2006-2010 $305,375) $44,395 $31,150 $62,000 $171,418 $306,982
National Institute for Health (USA)
• Control of Menstrual Bleeding Disturbances in Women Principal Investigators: I Fraser, L Salamonsen, J Findlay, M Hickey. (2003-2007 $287,409) • Consortium Grant - New Mediators of Clinical Lung Maturation Investigators: A Jobe, M Ikegami, J Newnham. (2005-2008 USD$470,159) • Neonatal Resuscitation and Preterm Lung Injury Principal Investigators: A Jobe, M Ikegami, J Pillow. (2005-2009 USD$280,000) $34,609 $58,638 $155,989
Clive & Vera Ramaciotti
• Influence of Ventilation Strategy and Lung Disease on Patterns of Air Distribution in the Preterm Lung Investigator: J Pillow (2006 $30,000) $30,000
Raine Medical Research Foundation
• Identifying Genetic Markers of Periodontal Disease Associated with Pre-term Birth Principal Investigator: C Pennell (2006-2007 $185,689) $95,658
National Breast Cancer Foundation
• The Development and Evaluation of a Menopause Information Tool for Young Women Following Breast Cancer Investigators: M Hickey. (2005-2006 $119,785) • March of Dimes - The Diagnosis of Pre-term Labour Investigators: S Lye, C Pennell, A Bocking, A Oldenhoff. (2005-2008 $316,956) $53,411 $45,620
The Asthma Foundation of Western Australia Inc
• Fetal Sensitization and Postnatal Airway Reactivity Principal Investigator: J Pillow (2005-2006 $44,700) $36,888
WIRF Annual Report 2007 Page 43
Sylvia & Charles Viertel Charitable Foundation
• Senior Medical Research Fellowship – Understanding the Relevance of Biological Complexity and Fractal Structures for Ventilation of the Preterm Lung. Principle Investigator: J Pillow (2007 – 2011 $975,000) $97,500
Department of Health - WA
• Models of Maternity Care: A Review of the Evidence Investigators: J Henderson, J Hornbuckle, D Doherty (2007 $36,363) $36,363
Commercial Research Support
• Colgate – Palmolive Pty Ltd Sponsorship of Dental Hygienists employed on NHMRC project grant “Prevention of pre-term birth by treatment of periodontal disease during pregnancy” (2005 – 2008 $108,000) • Organon (Australia) Pty Ltd Evaluating the contraceptive efficacy, cycle control, safety and acceptability of a monophasic Combined Oral Contraceptive (2006 – 2008) • Bayer Schering Pharma Ag Study of Oral Estradiol Valerate / Dienogest tablets for the treatment of dysfunctional uterine bleeding (2006 – 2008) • Pfizer Australia Pty Ltd Evaluating the efficacy and safety of PD0299685 for the treatment of moderate to severe vasomotor symptoms associated with menopause (2006 – 2007) • Fisher & Paykel $25,980 $44,780 $48,298 $60,710 $36,000
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 and the Capacity Building Grant, 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: $1,048,401
Total Research Support for 2006/2007
$2,524,790
WIRF Annual Report 2007 Page 44
Income Statement and Balance Sheet
Women & Infants Research Foundation Inc.
Income Statement for the Year Ended 30 June 2007
2007 $
Revenue Depreciation expenses Research grants approved Other research expenses Administration expenses Trading Activities - Cost of Goods Sold & other expenses Finance Costs Profit before income tax Income tax expense Profit from ordinary activities for the year 2,939,317 -90,565 -52,334 -996,067 -250,115 -908,686 -4,622 636,928 636,928
2006 $
2,622,539 -89,111 -75,483 -725,485 -248,678 -806,799 -3,136 673,847 673,847
Women & Infants Research Foundation Inc.
Balance Sheet as at 30 June 2007
CURRENT ASSETS Cash and cash equivalents Trade and other receivables Inventories Other current assets TOTAL CURRENT ASSETS NON-CURRENT ASSETS Financial assets Property, plant and equipment TOTAL NON-CURRENT ASSETS TOTAL ASSETS CURRENT LIABILITIES Trade and other payables Short term provisions TOTAL CURRENT LIABILITIES NON-CURRENT LIABILITIES Long term provisions TOTAL NON-CURRENT LIABILITIES TOTAL LIABILITIES NET ASSETS EQUITY Retained Earnings Reserves TOTAL EQUITY 5,120,200 1,094,727 6,214,927 4,526,701 833,463 5,360,164 18,373 18,373 1,115,045 6,214,927 20,504 20,504 1,001,804 5,360,164 1,029,291 67,381 1,096,672 935,259 46,041 981,300 5,344,449 454,819 5,799,268 7,329,972 4,551,824 457,067 5,008,891 6,361,968 869,841 597,898 19,788 43,177 1,530,704 1,075,921 217,408 25,025 34,723 1,353,077
2007 $
2006 $
A full copy of the Foundation’s audited general purpose financial report for the year ended 30 June 2007 is available at www.wirf.com.au
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