Breathing new life into neonatal research

A premature infant's lungs lack a critical chemical that allows them to 'open' or 'fill'. To address this issue, the largest ever respiratory intervention trial is now underway in delivery rooms across the world.

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General public

Premature infants will benefit from this ground-breaking study, which has led to the largest respiratory intervention trial in delivery rooms to date. The new treatment not only changes the way doctors resuscitate preterm infants, but also lends itself for use in almost any hospital because it uses standard equipment.

Treating delicate lungs with care

One in 10 babies arrives early, and an increasing number are born earlier than 29 weeks of pregnancy. Thanks to advances in neonatology these extremely preterm infants usually survive, but with a huge risk of lifelong health complications.

‘Premature birth is essentially a respiratory problem’, said Dr David Tingay, Associate Professor from the Murdoch Children’s Research Institute (MCRI).

‘Babies have to start breathing air well before their lungs are fully developed to do so. Not only does this make it hard for preterm babies to do, but it places these very fragile lungs at great risk of injury. Once lung injury starts it is a slippery slope.’

Dr Tingay explained that premature babies’ lungs lack a critical chemical that allows them to ‘open’ or ‘fill’. At birth, these babies’ lungs are filled with liquid and are poorly supported by underdeveloped muscles in the chest wall.

To try to address the problem, the largest ever delivery room respiratory intervention trial is now underway.

Small changes make a big difference

The trial will adapt a technique called positive end-expiratory pressure (PEEP) for the delivery room. PEEP supports the premature lung at birth in a way that Dr Tingay likened to blowing up a balloon. ‘There’s a fine balance between too little, too much and just right’, he observes.

He has worked with PEEP since his PhD studies in the early 2000s, searching for the most effective levels to apply to stabilise preterm infants.

He argues for dynamic PEEP. ‘It’s a form of “personalised” medicine where the clinician gives the therapy that the individual baby needs at that time’, he said.

His work showed that PEEP levels altered lung volume and oxygen levels in very sick babies in the Neonatal Intensive Care Unit. Professor Anton van Kaam conducted similar investigations in the Netherlands.

POLAR power

The trial is part of the global POLAR trial into the use of PEEP worldwide. POLAR is the largest clinical study of its kind.

Through an International Clinical Trials Collaboration grant, the Medical Research Future Fund (MRFF) awarded $1,387,654 to the project.

‘The MRFF has been instrumental to the POLAR trial’, Dr Tingay said.

‘Without the grant, we wouldn’t have had the funding to conduct our trial.’

Support from MCRI for the trial comes through its Melbourne Children’s Trials Centre.

The POLAR trial team includes 9 researchers from Australia, Europe and North America. All are global leaders in the neonatal respiratory arena.

Several elements make the project unique, including its massive reach and its baby-led focus of care. The initiative aims to study 906 infants from their very first breaths.

Importantly, the trial also possesses a ‘simplistic beauty’, as Dr Tingay refers to it. Clinicians can use the breathing and oxygen systems that exist in almost every delivery room in the world. The project has the potential to guide hospital staff in diverse healthcare settings.

More information is available at the POLAR trial website.

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