Improving respiratory outcomes for preterm babies

Can you describe the aim of your research in 10 words?

To improve the immediate and long-term outcomes of premature infants

What have you achieved in this area so far?

Early research focused on the use of high-frequency oscillatory ventilation (HFOV) and how it can be used safely to protect the immature lung. I have also undertaken some novel research understanding the non-invasive equivalent of HFOV – bubble CPAP.

This very simple and inexpensive treatment offers effective respiratory support to infants with mild-moderate respiratory disease around the world. Arising out of both of these areas of research is some groundbreaking work showing that variable ventilation is more efficient for the premature infant – removing waste gas with lower levels of mechanical ventilatory support than controlled pressure and rate controlled mechanical ventilation.

We are now extending this research to include variable high-frequency ventilation. Likewise, we have started to investigate the role of the diaphragm in respiratory disease in premature infants. This research has really changed our approach to ventilating preterm infants, increasing our focus on encouraging the baby to do some of its own breathing, rather than taking over and controlling the breathing for them.

More recently, and especially since the establishment of our NHMRC Centre of Research Excellence on Improving the Immediate and Longer Term Outcomes of Preterm Infants, I have diversified my research to address more systemic issues – particularly inflammation.

Inflammation results from mechanical ventilation of the premature infant, but also from exposure to infection in the womb, postnatal infection, or disturbance of the gastrointestinal system due to early exposure to. Inflammation has adverse consequences for many different body systems, so finding a way to reduce the inflammatory consequences of preterm birth really offers us a way forward to significantly improve the immediate and longer-term outcomes.

 What aspect of this research excites you the most?

The recent shift to addressing more holistic issues such as inflammation is an especially exciting development. This shift recognised the importance of understanding how changes to any one system affected the whole infant, and especially, the importance of combating problems that impact the preterm infant at multiple organs/levels. Research that is comprehensive and holistic in its approach has a much higher likelihood of translation to clinical care.

What’s your Holy Grail – the one thing you’d like to achieve in your career?

Finding an effective and inexpensive immunomodulatory treatment that prevents or reduces the adverse consequences of inflammation and infection associated with preterm birth – so the long-term outcomes of these infants are maximised and the impact of their premature delivery on family and society is reduced.

How long before your work impacts patient care?

Some work has already impacted care via clinical guidelines. Some work is in the process of translation e.g. clinical trials evaluating the impact of delivery of surfactant to the lung during non-invasive ventilation.

Other upcoming preclinical studies will provide the evidence to support new neonatal treatments over the next five years e.g. stem cells to reduce severity of bronchopulmonary dysplasia, creatine to protect the preterm infant from brain injury and respiratory failure, and innate defence regulators to reduce inflammation and postnatal infection in preterm infants.

 Who has inspired you?

I am most inspired by my colleagues, many of whom work in diverse and often non-medical disciplines.  Collaboration and listening to and learning from others continues to inspire me on a daily basis with new ideas that may have application to the problems facing the preterm infant.

 Describe your perfect day.

A chance conversation with a colleague identifying a novel idea warranting development; notification of acceptance of a manuscript describing a new treatment to improve outcomes of preterm infants; being granted an award to explore a new and exciting idea; seeing one of my students present their work on an international stage to wide acclaim; mentoring a junior colleague or knowing that my input will have had a major influence on their career.

If you could only keep three possessions, what would they be?

My computer, our country property and my woodturning lathe. I love the creativity of turning wood from a rough log into something truly beautiful.

 Can you nominate a book that influenced you?

Chaos by James Gleick and Linked by Barabási Albert-László. Together these books were instrumental in influencing my understanding of and approach to biological behaviours, networks, the seemingly incomprehensible complexity of chronic disease, and how everything is linked. I think these helped me realise that I needed to focus on treatments of systemic processes rather than singular aspects of disease to really improve preterm infant outcomes.

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