Charles Roehr - preterm babies breathing

Thanks to dedicated research, Medical Science is rapidly improving. In particular, the sciences concerned with the management of babies which are born way too early, that is before their due date, which is usually around 40 weeks of pregnancy, is a fast evolving and most challenging field. Today, babies born as early as 16 weeks before their due date have a good chance of survival. Such infants will need intensive care treatment at the start of life, in order to survive. But survival can be associated with significant side effects, such as long standing problems with breathing through early childhood. Therefore, much research effort goes into finding the best possible way to help preterm infants survive without longstanding illness. One way of doing so is to find the most effective way on how to help preterm babies breathe. The aim is to the help babies get air into their lungs and breathe. This is usually done by placing a breathing tube down the babies windpipe. Doctors try to do this without hurting the child or letting the lungs suffer from the process. Once the tube is in place, doctors can assist the baby with its breathing. To do this gently, knowledge of the applied breathing volumes is necessary. Specially designed instruments can give breath by breath feed back on the volume of air going in and out of the lung. Also, the concentration of oxygen can be tailored according to the child’s requirements. The paper presented here investigated a different breathing gas than oxygen, it investigates carbondioxyde (CO2), which is present during normal gas exchange. Several studies have shown that knowledge of the concentration in the breathing gas coming from the baby may have value for the treatment of infants requiring help with breathing. We looked at how reliable the concentration of CO2 can be detected when there is a breathing tube in place. In our laboratory experiment, using a dummy, a breathing simulator and some breathing tubes, we found that the concentration of CO2 in the breathing gas can not be reliably measured in the presence of increasing leak around the breathing tube. This research will help doctors interpret the breathing gas concentrations of CO2 in the future and hopefully help gain more important information on how to best support the breathing of very prematurely born infants.


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Stem Cells and Cerebral Palsy

Centre Director, Euan Wallace, participated in a Public Forum on stem cells and cerebral palsy last night in Sydney at the Cerebral Palsy Alliance HQ in Allambie Heights, NSW.

The CP Alliance, https://www.cerebralpalsy.org.au, ran a fantastic event at the fabulous CP HQ. A webcast of the event is accessible via the CP Alliance website.

The forum discussed the prospects of using stem cells as a therapy for CP including establishing a national clinical trial in Australia.

Stay tuned for advances in this field. The Centre's Professor Michael Fahey and Euan Wallace are leading this initiative in collaboration with colleagues nationally.

Dummies may reduce the risk of Cot Death

Research presented by the Centre's Rosemary Horne at the annual Pediatric Academic Societies' meeting in the US this week shows how and why giving your baby a dummy (soother) reduces their risk of Sudden Infant Death.

The work is featured by the ABC Science today:
http://www.abc.net.au/science/articles/2013/05/06/3751068.htm

Rosemary and her team in the Infant and Child Health Theme at The Ritchie Centre  have provided world-first insight into what happens when a baby sucks on a dummy. They have shown that sucking increases a newborn baby's heart rate function, improving how the heart rate responds the blood pressure. This effect is seen in the babies who were given a dummy even when they weren't using the dummy.

How is this related to Cot Death (Sudden Infant Death Syndrome)?

Rosemary's team have previously shown that babies at high risk of SIDS are much less able to make adjustments in their heart rate and blood pressure and less able to arouse from sleep when blood pressure falls. This new work shows that babies who are given a dummy have much more responsive heart rates and so more able to compensate for changes in blood pressure. This suggests that they will be at much lower risk of SIDS.

The excitement in this work is that it provides an understanding of why using a dummy may reduce SIDS. It gives new parents the science they so badly need to help them best look after their precious newborn baby.

As always, there is more to do and much more to learn but at least Rosemary and her team have provided one more piece of the jigsaw.

Looking forward to the end of SIDS. Well done Team.

PhD student International Success

Ms Stacey Ellery is at it again, this time receiving a prestigious travel award from the International Paediatric Research Foundation and the journal, Pediatric Research. Stacey was selected as a winner of the "Best Paper Travel Award" for junior authors based on her recent publication in Pediatric Research.
Read her award winning manuscript here.

Congratulations Stacey, keep up the good work.

Professor Dan Rurak – Biological Reasons for Stillbirths

Late last year (August 2012), the Ritchie Centre was delighted to have Professor Dan Rurak, all the way from the University of British Columbia in Vancouver, present some very interesting work about possible biological mechanisms for stillbirths, particularly those that occur late in gestation.

Professor Rurak presented data on the oxygen supply and demand of the fetus in the womb. His findings highlighted that the oxygen delivery to the fetus decreases with advancing gestational age due a reduction in its supply. For example, there is a decrease in blood flow/kg of fetal weight from 35 weeks of gestation until term and the increase in uterine blood flow does not keep up with the rapid increases in fetal growth rate. What needs to happen, therefore, is that the fetus must somehow decrease its fetal oxygenation consumption to balance out the reduction in supply. During a normal pregnancy this is achieved by the fetus reducing body movements, such as fetal breathing movements, and the rate of growth of the femur declines with increasing gestation.

The implication of these findings may influence conditions such as pre-emclampsia (hypertension during pregnancy) or post-term pregnancy (where the baby has not been born after 42 weeks which is the normal duration of pregnancy). In these conditions, where there is either a compromise in oxygen or a compromise in the demands of the fetus, there may be a mismatch in the supply and demand of the oxygen and these may play a role in the occurrence of stillbirths.
The Ritchie Centre has certainly been very impressed by Professor Rurak’s work that has been a fascinating look into the highly complicated and regulated process of pregnancy.

The Ritchie Centre Seminar Series: Ethics and Moral Distress in the PICU - Dr Sarah te Pas

The Ritchie Centre Seminar Committee was pleased to host Dr Sarah te Pas, a paediatric intensivist from the Sophia Children’s hospital at Erasmus Medical Centre, Rotterdam, in the Netherlands, speaking about ethics and moral distress in the Paediatric Intensive Care Unit (PICU).  By her own admission, Sarah is not an ethicist but has an interest in the ethics of care related to her work and has completed a master’s degree in the “Ethics of Care”.  Sarah provided the audience with some theoretical background on ethics, ethics in science and ethics in medical care referring to the four cardinal virtues of ethics included prudence, justice, temperance and courage and the pillars of the Hippocratic Oath including autonomy, beneficence, non-maleficence and justice.  When the concept of justice is involved in the ethics of care it becomes complicated as equal distribution of health care services and the costs involved become issues. 

Sarah also discussed moral distress, which occurs when a person knows what the right thing to do is but is unable to do it due to some constraint.  This is in contrast to ethical dilemma’s, where a person is grappling with what is right and what is wrong.  The most common cause of moral distress in the PICU is when parents and doctors disagree on treatment.  For example, the treating physicians may believe that treatment will result in an unacceptable residual morbidity and impairment of quality of life and therefore that treatment should be withdrawn and the patient palliated.  However, as it is the decision of the parents, if the parents want treatment to be continued regardless of the potential long-term outcomes, then it must be continued.

Sarah presented a case to the audience of a 12 week old, term born infant who was diagnosed with a rare genetic condition which resulted in ventilator dependent hypoventilation with a high likelihood that the infant would remain ventilator dependent for the rest of her life.  In addition, the condition was associated with a range of other problems including cardiac arrhythmias, gastrointestinal problems, urogenital problems etcetera.  However, as the condition was so rare, little is known about the likely prognosis making it difficult to properly inform the parents of her likely long-term outcome.  Through discussion with the audience Sarah described the Utretcht model of decision making which involves exploring, defining, analysing and weighing up options before a moral decision can be made. 

We thank Sarah for a very interesting discussion.