Research in Neonatal Paediatrics at King Edward Memorial Hospital focuses on preterm infants: their breathing, feeding, infections, growth and development.

Lung Function of Preterm Infants

Preterm infants have immature lungs and respiratory failure is a frequent problem.  We have recently established a respiratory laboratory where we investigate the lung function of infants when they are breathing spontaneously or when they are artificially ventilated. 

The methodology allows us to evaluate the impact of different treatment strategies on their respiratory development. Recent funding has enabled us to purchase up-to-date equipment to monitor lung function at the bed-side. This will help us determine how best to support the ventilation of very preterm infants and thus improve their survival, and reduce the incidence of ongoing respiratory problems in their first year of life.

Human Milk Bank

Once the infants recover from their acute respiratory disease, we need to provide nutrition intravenously or via a naso-gastric tube.  Infants fed breast milk have less infections, gut problems and better intelligence than those fed formula but often mothers of preterm infants who need to express their milk find it difficult to provide sufficient milk to meet their baby’s need.

We have bought equipment to establish the first contemporary human milk bank in Australia.  This will allow us to provide human milk or human milk products to preterm and ill infants in Western Australia as a more nutritious alternative to cow’s milk formula and fortifiers.  Our research has helped develop the most effective method of pasteurising donated human milk to eliminate transmitted viruses and bacteria while preserving the unique bio-active properties. 

Ongoing research will enable us to concentrate donated milk to better meet the high nutritional requirements for growth of extremely preterm infants. Through the Foundation, we have also employed a Director of the Human Milk Bank for the next year to implement quality control mechanisms and to oversee research and development phases.

Nutritional Supplementation for Preterm Infants

Before birth, the unborn child receives some nutrients from the placenta in amounts much higher than is possible through breast milk after birth.  Randomised clinical trials of nutritional supplements aimed at improving development of infants born 3-4 months early are conducted across Australia with KEMH being the largest contributor. 

We are currently studying the effects of fish oil supplementation of mother and infant on child intelligence.  Fish oil contains large amounts of fats delivered across the placenta in the last trimester of pregnancy or via human milk.

Bowel Injury in Preterm Infants

One of the risks of feeding preterm infants milk is the serious and potentially fatal illness called necrotising enterocolitis. To reduce the incidence of this condition, we have developed an experimental animal model to test the effectiveness of an immune modulating drug (Pentoxifylline).

Our study has shown that this drug is safe and we are planning a clinical trial in 2006 to confirm this benefit in infants.

Development of Immunity in the Preterm Infant

Infection continues to be a common cause of death and disability in the preterm infant. We have commenced a large study called the Study of Postnatal Immunity of the Neonate (SPIN) in which we are recruiting 500 preterm and term mother-infant pairs at birth and investigating immune development during early childhood. 

The laboratory assays are correlated with clinical outcomes including neonatal and childhood infection, response to routine immunisations and risk of allergic disease.  We have shown that the neonatal immune system is deficient in generating many inflammatory responses, and further that specific signalling pathways are deficient in preterm infants compared with term infants, and that this may contribute to their particular vulnerability to severe infection. Better understanding of the factors that influence the developing immune system of preterm infants will allow us to target treatments more effectively. We have developed clinical indicators to allow us to better monitor infection rates and the effects of interventions.

Aerial Transport of Preterm Infants

KEMH is the only tertiary perinatal centre in Western Australia and where 95% of very preterm infants in the state are born.  We transfer infants from our Neonatal Intensive Care Unit as soon as they are stable to their home town. In Western Australia, this can mean small babies travelling vast distances by air travel when they are exposed to reduced oxygen levels. 

The precise effect on babies, particularly those born preterm, of this reduced oxygen level has not been scientifically evaluated.  We are now studying the accuracy of current pre-flight “safe to fly” tests with the aim of enabling safer flying protocols to allow our young neonatal graduates to return home as soon as possible.

Caring for Preterm Babies at Home

Once home, we follow the growth and development of our most immature patients. Nutritional guidelines for these infants currently do not exist. We are monitoring the energy intakes and growth of preterm infants with chronic lung disease over the first year of life to develop national guidelines to assist parents and health care workers to support these vulnerable children

Perron Rotary Express Milk Bank (PREMB)

Extremely preterm infants born under 1000gms may be considered a ‘nutritional emergency’.  Weight loss often exceeds 10% and birth weight is often not regained for two weeks.  When these infants are able to tolerate enteral feeds, the recognised best source of nutrition is mother’s own breastmilk.  These neonates are born with an immature immune system and the immuno-protective properties present in human milk represent an important complement to the mucosal barrier of the developing gut.  However there are several circumstances that may inhibit a mother from providing breastmilk for her child.  These include maternal illness, failure to initiate or maintain lactation and geographical isolation. 

In neonatal intensive care units in Australia, unlike many other developed countries, cow or soy protein based artificial formula and fortifier are the only sources of alternative nutrition available in these instances.  Unfortunately, artificial formula feeding is associated with increased incidence and severity of gastrointestinal infection.  Throughout Europe, North America and the UK (among others) pasteurised donor human milk is made available to these infants.  Healthy lactating mothers have donated their excess milk and it is pasteurised to ensure the removal of any potential contamination by micro-organisms. 

The PREMB is being developed with collaboration between WIRF, King Edward Memorial Hospital for Women and The University of Western Australia from funding from the Rotary Clubs of Belmont and Thornlie and Stan Perron.