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Contact the PSANZ Secretariat at:                                                                       February 2014
12 Upper Wights Mtn Rd, Samford QLD 4520
PO Box 488, Samford QLD 4520
0417 772 996
admin@psanz.com.au
www.psanz.com.au
Dear *|FNAME|*
We are always looking for items of interest for the PSANZ community. Please send news of your branch, sub-committee or SIG, of upcoming meetings or an article you found relevant via email. They could make an appearance in the next e-news! We appreciate all contributions.

Please feel free to email Wendy Crockford at admin@psanz.com.au or phone on 07 3289 3656 or 0417 772 996 if you have any queries or concerns relating to PSANZ.

PSANZ 2014 Congress

Please see the program flyer and registration form, including speakers and topics. Submit your registration today to secure your place. We look forward to welcoming everyone to Perth! 
Click here to register.
Keep up to date with the latest research from numerous segments of the PSANZ umbrella and take the opportunity to increase your network across the globe.

The upcoming PSANZ 18th Annual Conference is being held at the award winning Crown Convention Centre in Perth from 6-9 April, 2014. 

This year, PSANZ is working with DOHaD (Developmental Origins of Health and Disease).  Both programs will unite on the morning of Wednesday April 9, with the PSANZ closing ceremony at 2pm.  The DOHaD meeting will then continue on in the afternoon of April 9 and conclude at 5pm on April 10. â€¨ â€¨Registration is available for the three day PSANZ conference PLUS the DOHaD conference (at a discounted rate).  More details on the registration page. 
Click here to see all the details.

Extra Workshops in association with PSANZ

This year you have the opportunity to attend several associated workshops, each with a specific focus, either side of PSANZ2014. See below for the array of workshops on offer.
 
The 28th Fetal and Neonatal Workshop
Yanchep Inn, Yanchep National Park, Yanchep, Western Australia
4-5 April, 2014
  • The Workshop will be held at the Yanchep Inn, Yanchep National Park, Yanchep, WA, on Friday 4 - Saturday 5th April, 2014. 
  •  Shared accommodation will be available from $25 to $70 per night
  • The conference dinner will be held on Friday 4th, April.
  • Final registration costs, dates for registration and abstract deadline will be sent out shortly.
  • Registration will be open in early January, from HERE
  • Transport to and from Perth will be organised for those who need it.
  • Due to the success of the private winery tour in Adelaide, plans for a similar event is being organised for Thursday, 3rd April, for those interested. More information to follow.
IMPACT Workshop
Interdisciplinary Maternal Perinatal Australasian Clinical Trials network
IMPACT is holding its Annual Workshop immediately proir to the Congress
Date:   Saturday 5th April, 12.30pm to 5.00pm and Sunday 6th April, 09.00am to 1.30pm
Venue: Crown Convention Centre. (Same venue as the Congress)
Main themes include:
  • Use and impact of composite outcomes in clinical trials
  • PSANZ Clinical Trials Network - how best to organise a clinical trials network in Maternal and Babies health
Click here for more details

 

Quality and Safety in Perinatal Care
The annual PSANZ Satellite Workshop of the PSANZ PMG and ANZSA. 
King Edward Memorial Hospital, 374 Bagot rd. Subiaco, Western Australia
Thursday, 10th Aptril 2014, 8.30am to 14.30pm
Session 1: A workshop on identification of areas for improving outcomes for mothers and babies through identification of contributory factors and potentially avoidable adverse maternal and neonatal outcomes. Session 2: Improving the detection of fetal growth restriction.Please see the program flyer and registration form, including speakers and topics. Submit your registration form today to secure your place.

Click here for full details.
 

Writing a Scientific Manuscript
Crown Perth Convention Centre, Botanical Room 4 Great Eastern Highway, Burswood, WA
Sunday 6th April

Workshop Leader/Facilitator:
Professor Kurt H. Albertine PhD, University of Utah
Writing a Scientific Manuscript  – you will review principles of critical evaluation and clear writing, and participate in an interactive session focused on critiquing examples of participants writing.
Registrations close on 10th March.
Click here for more information and to register,

 
Advanced Mechanical Ventilation in Neonates
Venue Day One: Crown Perth Convention Centre, Studio Room Great Eastern Highway, Burswood
Venue Day Two: Large Animal Facility The University of Western Australia, Crawley
Thursday 10th April
and Friday 11th April
Advanced Mechanical Ventilation in Neonates – for advanced neonatal trainees and consultant neonatologists, with the option to attend day one (lecture format) or both days (second day is hands-on).
Registrations close on 10th March.
For more information and to register, Click here

 

PSANZ Policy Subcommittee

 New Committee
As part of the implementation of the PSANZ strategic plan, a policy sub-committee has been established.  
Through this sub-committee, PSANZ will comment upon and provide coordinated feedback to local / national / international bodies on external documents relevant to our mission.  PSANZ is currently developing a priority list of policies for maternal and newborn care and will soon be seeking your suggestions from the membership on this list. In addition, the sub-committee will review existing PSANZ policy documents and draft new policies as they are required.  
 
One of the first current PSANZ policies that the sub-committee will review is the policy on industry sponsorship.  It is apparent that the current policy has not always been rigorously enforced over the past few years and it is, therefore, timely that PSANZ should review this and update it if appropriate.  The sub-committee will also consider guidelines to ensure that the current or updated policy is adhered to for all PSANZ sponsored / endorsed events.
 


PSANZ Perinatal Palliative Care

A newly formed SIG introduces itself
Following a Senate Inquiry into Palliative Care in Australia, held in 2012, members of PSANZ and others working and researching in the field of perinatal palliative care formed the PSANZ Perinatal Palliative Care Special Interest Group (PPC SIG) to respond to concerns raised during the Inquiry about the lack of specialist perinatal palliative care in Australia.
The PSANZ PPC SIG was formed in 2013 and aims to promote research, education, and improved service delivery in perinatal palliative care in Australia and New Zealand. The PPC SIG held its inaugural meeting at the Royal Children’s Hospital in Melbourne in July 2013. The symposium attracted a large number and variety of professionals from Australia and New Zealand and helped identify some of the key issues that need to be addressed in the near future. We identified the wealth of expertise in Australia and New Zealand and committed to developing stronger links across multiple disciplines and institutions in different jurisdictions.
Some of the PPC SIG’s current activities include:
  • The pooling of resources from health organisations in Australia and New Zealand with a view to wider dissemination so that professionals in the field may all benefit from work already undertaken 
  • The design of a needs analysis to identify gaps in service delivery and education
  • The development of training programs specific to perinatal palliative care
  • Collaboration with other PSANZ SIGs
  • Collaboration on research projects such as the Praecox Program (details of which are provided below)
The Praecox Program is an initiative lead by neonatal nurse and researcher, Dr Victoria Kain, from Griffith University’s Centre for Health Practice Innovation.  The aim of the program is to develop an evidence-based, multidisciplinary educational intervention to advance neonatal palliative care practice, and to improve clinical care for dying neonates and their families.  The Program has received seeding funding from the Royal Brisbane & Women’s Hospital Foundation to fund a pilot study, which will develop and evaluate the first of three online modules.  The Praecox Program is expected to benefit dying babies, their families and the healthcare professionals caring for them.  Dr Kain can be contacted at v.kain@griffith.edu.au.
If you are interested and want to contribute your experience and knowledge for the improvement of perinatal palliative care in Australia and New Zealand, please contact us. Some of the fields from which we draw expertise are neonatology, nursing, palliative care, midwifery, obstetrics, research, interest groups, and from individuals who have experienced neonatal palliative care.
For further details on how to become a member of the PPC SIG, please visit http://www.psanz.com.au/special-interest/perinatal-palliative-care-sig or contact the Secretary, Dr Vicki Xafis, at vicki.xafis@adelaide.edu.au.

 

Geoffrey Thorburn Visiting Professor

Professor Bonnie Stevens


New Investigator Research Award Winners

Award winners featuring summaries of their research this month are Amy Kier, Brett Manley and Justin Lang
Amy Kier
Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant
 
Authors: Keir A, McPhee A, Stark M, Andersen C
Pediatric Research 2013: 73(1); 75-79. doi: 10.1038/pr.2012.144
 
Background:
Transfusion of packed red blood cells (PRBCs) saves lives in the neonatal critical care setting and is one of the most common interventions in the preterm infant. The number and volume of PRBC transfusions are associated with several major neonatal morbidities, although a direct causal link between transfusion and major neonatal morbidity is still to be proven. Transfusion-related immunomodulation (TRIM) may underlie these adverse outcomes, yet it has received little attention in the high-risk preterm infant.
 
Methods:
One transfusion event was studied in infants ≤28 weeks gestation between 2 and 6 weeks postnatal age (n = 28). Plasma inflammatory cytokines and markers of endothelial activation were measured in the infants before and 2–4 h after transfusion, as well as in the donor pack.
 
Results:
Median (range) age at transfusion was 18 (14–39) days with the pre-transfusion haemoglobin level at 9.8 (7.4–10.2) g/dl. Interleukin (IL)-1β (P = 0.01), IL-8 (P = <0.001), tumour necrosis factor-α (P = 0.008), and monocyte chemoattractant protein (P = 0.01) were increased after transfusion. A similar elevation in markers of endothelial activation was seen after transfusion with increased plasma macrophage inhibitory factor (P = 0.005) and soluble intracellular adhesion molecule-1 (P = <0.001).
 
Conclusion:
Production of inflammatory cytokines and immunoactivation of the endothelium observed after the transfusion of PRBCs in the preterm infant may be a manifestation of TRIM. The implications of this emerging phenomenon within the preterm neonatal population warrant further investigation.
The study was published in its entirety in Pediatric Research (2013) 73, 75-79 doi:10.1038/pr.2012.122.  If you would like a full copy of the study please contact Amy at amy.keir@sickkids.ca

Amy Keir MBBS MPH FRACP is a Neonatal Fellow at Division of Neonatology, Department of Paediatrics, University of Toronto
 
Brett Manley
Brett Manley:
High-flow Nasal Cannulae vs. Nasal CPAP for Post-Extubation Respiratory Support of Very Preterm Infants: A Multicentre, Randomised, Non-Inferiority Trial.


Authors: Manley BJ, Owen LS, Doyle LW, Andersen CC, Cartwright DW, Pritchard MA, Donath SM, and Davis PG.

Very preterm infants, born more than two months early, often have breathing problems requiring treatment in a neonatal intensive care unit (NICU). In the past, these infants were treated with a mechanical breathing machine (ventilator), but in recent decades there has been a shift to more 'non-invasive' forms of breathing support in an attempt to reduce injury to the lungs and prevent chronic lung disease of prematurity. Nasal CPAP has been used to treat preterm infants for several decades, and has been shown to be an effective mode of non-invasive support for preterm infants. Nasal CPAP helps keep the lungs of preterm infants open by blowing air and oxygen under pressure into the infant's nose via large nasal prongs. However, nasal CPAP has some downsides: it is sometimes uncomfortable for infants, can damage the nose, interfere with feeding and parent engagement, and has a bulky interface requiring a high level of nursing skill to manage.

A newer, simpler non-invasive technique is called 'high-flow'. High-flow uses smaller nasal prongs, and seems to be more comfortable for infants. Because of this, high-flow has become increasingly popular for treating preterm infants around the world, despite a lack of evidence for this practice from clinical trials. We undertook the HIPERSPACE trial to compare high-flow to nasal CPAP as support for very preterm infants coming off a mechanical mechanical (post-extubation) for the first time.

HIPERSPACE was a multicentre, randomised trial in Australian neonatal intensive care units. Participating centres were The Royal Women's Hospital, Melbourne, the Women's and Children's Hospital, Adelaide, and the Royal Brisbane and Women's Hospital. Very preterm infants were randomly assigned to receive either high-flow or nasal CPAP as post-extubation support. The main outcome we assessed was 'treatment failure' within seven days of starting the support. If high-flow failed, infants could receive nasal CPAP. If nasal CPAP failed, infants were placed back on the mechanical ventilator. We thought that if treatment failure occurred less than 20% more often in the high-flow group, that clinicians might choose to use high-flow because of its other advantages. Other outcomes assessed included the incidence of adverse events such as death, chronic lung disease, and air leaks from the lung.

A total of 303 very preterm infants took part in the trial. Treatment failure occurred in 52/152 (34%) of the high-flow group and 39/151 (26%) of the nasal CPAP group, a difference favouring nasal CPAP of 8%. Almost half of infants in whom high-flow failed were ‘rescued’ from needing to go back on the mechanical ventilator by nasal CPAP. There was significantly less nasal damage in the high-flow group, but no differences in the incidence of adverse outcomes.

We concluded that high-flow provides similar post-extubation support to nasal CPAP for very preterm infants, and causes less nasal damage. High-flow use in this role seems safe, as there was no increase in adverse events from its use.
Dr Brett Manley, MBBS (Hons.), FRACP is a Neonatologist at Neonatal Services and Newborn Research Centre, The Royal Womens Hospital, Melbourne
 
Justin Lang
My study investigates how blood flow increases within the lung at birth,  and how improving this increase can improve health outcomes  in vulnerable infants, particularly those requiring help to breath. In order for the newborn baby to survive the transition from a fetus to a newborn, many adjustments in physiology must be made, and made rapidly in order for the newborn to survive. Prior to birth, the placenta has the role of gas exchange, and the fetal lungs are in fact filled with fluid. As a result, blood flow within the lungs is low. However, at birth and removal of the placenta, the lung must rapidly take over the role of gas exchange. In order for it to do this, there must be entry of air into the lung to take over the role of gas exchange (breathing) and the re-direction of blood flow to the lungs to transfer oxygenated blood to the rest of the body. While this is a critically important adjustment to make, we don’t fully understand how this process occurs.
 
My research aims to understand what controls the changes in blood flow to the lungs at birth. Using a synchrotron, which generates powerful X-rays, we can image the air entering the lungs during the first breaths of life, and simultaneously assess blood flow in the pulmonary vessels; a technique which is not possible by any other means. By using this method, we can compare how changes to breathing at birth can affect the increase and location of blood flow in the lungs, in newborn rabbits. We previously expected the air entering the lungs to play the biggest role in increasing blood flow to the lung, but most recently, by ventilating just one lung with gas containing no oxygen, large changes in blood flow in the lungs was still observed. These changes happened even when no air was present and seemed to be caused just by gas entering a single lung. This is surprising as previously it was thought that oxygen needed to be present to stimulate an increase in blood flow to the lung. My studies are now investigating what factors increase blood flow in the lung at birth, and will redefine our current understanding underlying the increase in blood flow to the lung at birth.
Justin Lang is a PhD Candidate at The Ritchie Centre, Monash Institute of Medical Research
 


Pathways to Cerebral Palsy

Emeritus Professor Alastair MacLennan
The cerebral palsies are a heterogeneous group of non-progressive developmental disorders affecting movement and posture.
Their prevalence of 2–2.5 per 1000 births has changed little since cerebral palsy registers began 57 years ago, despite a sixfold increase in caesarean birth. They are heterogeneous in clinical type, in brain imaging pathology, in their association with other neurological disability and in their genetic and epidemiological associations.
In a recent paper published in Obstetrics and Gynecology researchers describe a case–control study of 494 singleton infants with cerebral palsy born after 35 weeks gestation, included on the WA Register of Developmental Anomalies, and 508 matched controls. They found that birth defects (42.3%) and fetal growth restriction (16.5%) contributed more to cerebral palsy than potentially asphyxial birth events (8.5%) and inflammation (4.8%).
These data confirm and extend the findings of other epidemiological studies and particularly underline the antenatal origins of most of the cerebral palsies.
The strong association of cerebral palsy with birth defects suggests genetic and epigenetic pathways to many of these cases. Very preterm delivery can initiate another common pathway via intraventricular haemorrhage, ventriculomegaly and white matter damage.
Next generation genetic sequencing technologies are allowing other pathways to cerebral palsy to be explored. Genetic susceptibility and environmental triggers may combine during pregnancy to stimulate networks and pathways to cerebral palsy that in the future may be amenable to intervention.
Fetal growth restriction, a major risk factor for cerebral palsy, can be missed if a customised birthweight for gestational age chart is not used that includes the sex and ethnic group of the newborn, and maternal height and weight (http://www.gestation.net/). The ponderal index can further assess asymmetrical fetal growth restriction, which is a sign of chronic fetal stress and may reflect existing pathology contributing to pathways leading to intrauterine neuropathology.
Growth-restricted fetuses may not tolerate labour well and acute-on-chronic hypoxia may arise, making the timing of the neuropathology difficult to ascertain.
Giving magnesium sulfate to women before very preterm delivery slightly reduces the risk of cerebral palsy and in selected cases of presumed intrapartum hypoxia head cooling may also reduce risk but these interventions have yet to impact much on the overall prevalence of cerebral palsy.
In particular, both elective caesarean delivery before labour and emergency caesarean delivery during labour have not reduced the risk of cerebral palsy as demonstrated in our systematic review and meta-analysis of observational studies, published last month in Obstetrics and Gynecology.
Thus there are no epidemiological data to support medicolegal assumptions that earlier caesarean delivery would have prevented a cerebral palsy outcome.
A very small number of cases of cerebral palsy could result purely from a severe acute asphyxial event in labour in a previously uncompromised healthy fetus, and there are published consensus criteria to help define these uncommon cases, which usually are associated with hypoxic sentinel events such as cord prolapse, uterine rupture and antepartum haemorrhage. In such cases speedy delivery is attempted and the available staff and facilities will determine the decision-to-delivery interval.
However, these intervals can garner criticism from armchair plaintiff medicolegal witnesses. Placental histology and arterial cord gases should be sought in all deliveries requiring obstetric or neonatal intervention to better inform and to minimise surmise.
Fear of cerebral palsy litigation and the high false-positive rate of electronic fetal monitoring contribute to the high rates (33%) of caesarean deliveries in Australia, the UK and the US.
An audit of maternity services in England last month decried the fact that 20% of expenditure in maternity services was for “negligence cover” and the main quantum was in cerebral palsy litigation.
Australian insurance agencies annually pay more than $200 million in mostly out-of-court settlements for cerebral palsy outcomes. Up to 70% of litigation costs are spent on the legal process.
The National Disability Insurance Scheme will not cover the main claim of litigants for “heads of damages”, eg, loss of income and quality of life, and thus cerebral palsy litigation is likely to continue to the detriment of maternity services. In comparison, funding for cerebral palsy research is a tiny fraction of these payments.
It is time Australia has a “no-fault” pension scheme for all cases of cerebral palsy, as it would be cheaper, much more equitable and it would exclude lawyers and expert witnesses.
Emeritus Professor Alastair MacLennan is the head of the Australian Collaborative Cerebral Palsy Research Group, Robinson Institute, Discipline of Paediatrics & Reproductive Health, The University of Adelaide.MacLennan A.

Cerebral palsy blame.MJA Insight December 9, 2013  Â© Copyright 2013 MJA Insight - reproduced with permission
 
Perinatal Palliative Care is just one of several Special Interest Groups which are part of PSANZ. Find out more about these groups HERE.
 

Recognition

Prof James King - OAM
Congratulations to Associate Professor James King who was recognised with a medal (OAM) in the General Division in this year’s Australia Day Honours for his service to medicine, particularly in the field of perinatal epidemiology.
 
James retired in 2011 after a medical career spanning nearly 50 years, the last decade of which was at the Women’s. His appointment at the Women's was as Perinatal Epidemiologist in the hospital’s Department of Perinatal Medicine. In that role, he conducted NHMRC-funded research on fetal welfare monitoring techniques, perinatal mortality and the use of clinical practice guidelines in Obstetrics.

James was chair of the Women’s Human Research Committee and also that committee's representative on the Hospital's Human Research Ethics Committee for 10 years.

 He was a driving force behind the Women’s regular perinatal mortality and morbidity audits for many years and has been an active mentor to clinical students and trainees in the areas of perinatal epidemiology and journal article interpretation. 


James has also made many contributions at state, national and international levels. He has been a lead reviewer for the Cochrane Collaboration pregnancy and childbirth database on major perinatal topics such as preterm labour and preeclampsia. In this role he has helped improve the perinatal management of these conditions throughout the world. 

He chaired the Victorian Consultative Council on Obstetric and Paediatric Mortality and Morbidity (2001–2007) and the National Maternal Mortality and Morbidity Advisory Committee (2004–2008), and was a member of the National Perinatal Data Advisory Committee (1995–2009). 

In all his professional activities, James displayed great knowledge, a wealth of experience, much wisdom, absolute honesty and integrity, unfailing courtesy and diplomacy, and admirable modesty.
In 2010 he was awarded one of the top staff awards bestowed by the Women’s, the Chair’s Award, for his outstanding contributions to maternal and perinatal quality and safety and to research excellence and ethical standards at the Hospital.


Susan Ryan Neonatal Seminar

Click here after 10th March for further details and to register


2014 UENPS conference in Athens

The 4th International Congress is being held in Athens, Greece on 11 - 14 December 2014.
Also, all participants coming from Australia and New Zealand will have a discount of â‚¬ 50 euros off the current registration fees.  

Please Click here for further details 
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