Better breath of life for premature babies
Babies born prematurely at less than 26 weeks of development have only a 10 per cent chance of surviving without brain damage. Some of this damage can be caused in their first 15 minutes by resuscitation efforts. Dr Graeme Polglase’s research into respiration and blood flow is changing resuscitation procedures and improving the survival odds for these newborns.
Graeme says one of the main challenges in reviving preterm infants is to evenly inflate the baby’s tiny, underdeveloped lungs. Mechanical ventilation, applied in more serious cases, can be too powerful. It can compress the airways and creating an uneven distribution of air and blood in the lung. This then disrupts blood flow to the heart and brain.
“A significant majority of brain injury in preterm infants after birth is caused by changes to blood flow to the brain,” Graeme says. “That can be through low blood flow (leading to cell death) and sudden change in blood flow, which can lead to haemorrhaging.”
He says many of the body’s self-regulating security systems have not yet developed in preterm infants. They do not have the mechanisms to manage rapid changes in blood flow.
A lucky preterm infant may escape their early arrival unscathed, or with only a minor learning disability. More severe effects include cerebral palsy.
Graeme’s research is part of a large project into foetal and neonatal lung development led by Professor Stuart Hooper at the Monash Institute of Medical Research. Collaborators include the Royal North Shore Hospital and the Royal Women’s Hospital. Outcomes of the joint research effort already include a new process called ‘sustained inflation’. It primes the lungs before mechanical ventilation to ensure all parts of the lung fill out evenly.
“Our studies are unique in that we’re investigating circulation in the systems all at the same time,” Graeme says. His research is partially funded by the Cerebral Palsy Foundation and also through a National Health and Medical Research Council (NHMRC) grant.
He is also part of Professor Hooper’s team, which is making use of the Australian Synchrotron to capture the respiration of newborn rabbits in the seconds after birth. It is the first imaging study to ever be able to see what actually happens in newborn lungs in those crucial first minutes.
Although he works with animal models, aspects of Graeme’s research have already been translated into a human clinical setting. Sustained inflation, which he is now refining, has become a widespread practice in treating preterm babies.
In another project, Graeme is examining the potential causes of brain injury during gestation. Inflammation in the uterus is the only known catalyst for preterm birth and may influence the baby’s initiation of breathing and the regulation of blood flow.
Assisting in the health and survival of premature infants is a far cry from Graeme’s early career intentions. He had planned to focus his studies on the computer science and electrical engineering fields. He became fascinated with physiology while studying science, which led him to biomedical engineering. The potential to create real human results has been a driving factor behind his research.
fetal and neonatal circulation and brain injury, fetal physiology, neonatal physiology, respiratory function, cardiovascular function, circulation
Vlassaks, E., Gavilanes, A.W., Bieghs, V., Reinartz, A., Gassler, N., Van Gorp, P.J., Gijbels, M.J., Bekers, O., Zimmermann, L.J., Pillow, J., Polglase, G., Nitsos, I., Newnham, J.P., Kallapur, S.G., Jobe, A.H., Shiri-Sverdlov, R., Kramer, B.W., 2012, Antenatal exposure to chorioamnionitis affects lipid metabolism in 7-week-old sheep, Journal of Developmental Origins of Health and Disease [P], vol 3, issue 2, Cambridge University Press, United Kingdom, pp. 103-110.
Crossley, K.J., Allison, B.J., Polglase, G., Morley, C.J., Harding, R., Davis, P.G., Moss, T.J.M., Hooper, S.B., 2012, Effects of caffeine on renal and pulmonary function in preterm newborn lambs, Pediatric Research [P], vol 72, issue 1, Nature Publishing Group, United States, pp. 19-25.
Musk, G.C., Polglase, G., Song, Y., Pillow, J., 2012, Impact of conventional breath inspiratory time during high-frequency jet ventilation in preterm lambs, Neonatology [P], vol 101, issue 4, S. Karger AG, Switzerland, pp. 267-273.
Polglase, G., Nitsos, I., Baburamani, A., Crossley, K., Slater, M., Gill, A., Allison, B., Moss, T., Pillow, J., Hooper, S., Kluckow, M., 2012, Inflammation in utero exacerbates ventilation-induced brain injury in preterm lambs, Journal of Applied Physiology [E], vol 112, issue 3, American Physiological Society, United States, pp. 481-489.
Polglase, G., Miller, S.L., Barton, S., Baburamani, A.A., Wong, F.Y., Aridas, J., Gill, A.W., Moss, T.J.M., Tolcos, M., Kluckow, M., Hooper, S.B., 2012, Initiation of resuscitation with high tidal volumes causes cerebral hemodynamic disturbance, brain inflammation and injury in preterm lambs, PLoS ONE [P], vol 7, issue 6 (Art. No: e39535), Public Library of Science, United States, pp. 1-8.
Kuypers, E., Collins, J.J., Kramer, B.W., Ofman, G., Nitsos, I., Pillow, J., Polglase, G., Kemp, M.W., Newnham, J.P., Gavilanes, A.W., Nowacki, R., Ikegami, M., Jobe, A.H., Kallapur, S.G., 2012, Intra-amniotic LPS and antenatal betamethasone: inflammation and maturation in preterm lamb lungs, American Journal Of Physiology-Lung Cellular And Molecular Physiology [P], vol 302, issue 4, American Physiological Society, United States, pp. L380-L389.
Kuypers, E., Collins, J.J., Jellema, R.K., Wolfs, T.G., Kemp, M.W., Nitsos, I., Pillow, J., Polglase, G., Newnham, J.P., Germeraad, W.T., Kallapur, S.G., Jobe, A.H., Kramer, B.W., 2012, Ovine fetal thymus response to lipopolysaccharide-induced chorioamnionitis and antenatal corticosteroids, PLoS ONE [P], vol 7, issue 5 (Art. No: e38257), Public Library of Science, United States, pp. 1-10.
Polglase, G., Hooper, S., Kluckow, M., Gill, A., Harding, R., Moss, T., 2012, The cardiopulmonary haemodynamic transition at birth is not different between male and female preterm lambs, Reproduction, Fertility and Development [P], vol 24, issue 3, C S I R O Publishing, Australia, pp. 510-516.
Li, S., Nitsos, I., Polglase, G., Braun, T., Moss, T., Newnham, J., Challis, J., 2012, The effects of dexamethasone treatment in early gestation on hypothalamic-pituitary-adrenal responses and gene expression at 7 months of postnatal age in sheep, Reproductive Sciences [P], vol 19, issue 3, Sage Publications, Inc., United States, pp. 260-270.
Dando, S.J., Nitsos, I., Kallapur, S.G., Newnham, J.P., Polglase, G., Pillow, J., Jobe, A.H., Timms, P., Knox, C.L., 2012, The role of the multiple banded antigen of Ureaplasma parvum in intra-amniotic infection: Major virulence factor or decoy?, PLoS ONE [P], vol 7, issue 1 Art. No: e29856), Public Library of Science, United States, pp. 1-15.
Berry, C.A., Suki, B., Polglase, G., Pillow, J., 2012, Variable ventilation enhances ventilation without exacerbating injury in preterm lambs with respiratory distress syndrome, Pediatric Research [P], vol 72, issue 4, Nature Publishing Group, United States, pp. 384-392.
Polglase, G., Kluckow, M., Gill, A., Allison, B., Moss, T., Dalton, R., Pillow, J., Nitsos, I., Andersen, C., Hooper, S., 2011, Cardiopulmonary haemodynamics in lambs during induced capillary leakage immediately after preterm birth, Clinical And Experimental Pharmacology And Physiology [P], vol 38, issue 4, Wiley-Blackwell Publishing Asia, Australia, pp. 222-228.
Kallapur, S., Kramer, B., Knox, C., Berry, C., Collins, J., Kemp, M., Nitsos, I., Polglase, G., Robinson, J., Hillman, N., Newnham, J., Chougnet, C., Jobe, A., 2011, Chronic fetal exposure to Ureaplasma parvum suppresses innate immune responses in sheep, Journal Of Immunology [P], vol 187, issue 5, American Association of Immunologists, United States, pp. 2688-2695.
Galinsky, R., Moss, T., Gubhaju, L., Hooper, S., Black, M., Polglase, G., 2011, Effect of intra-amniotic lipopolysaccharide on nephron number in preterm fetal sheep, American Journal Of Physiology-Renal Physiology [P], vol 301, issue 2, American Physiological Society, United States, pp. F280-F285.
Lee, A., Lambermont, V., Pillow, J., Polglase, G., Nitsos, I., Newnham, J., Beilharz, M., Kallapur, S., Jobe, A., Kramer, B., 2011, Fetal responses to lipopolysaccharide-induced chorioamnionitis alter immune and airway responses in 7-week-old sheep, American Journal Of Obstetrics And Gynecology [P], vol 204, issue 4, Mosby, Inc., United States, pp. e17-e24.
Musk, G., Polglase, G., Bunnell, J., McLean, C., Nitsos, I., Song, Y., Pillow, J., 2011, High positive end-expiratory pressure during high-frequency jet ventilation improves oxygenation and ventilation in preterm lambs, Pediatric Research [P], vol 69, issue 4, Lippincott Williams & Wilkins, United States, pp. 319-324.
Wolfs, T., Kallapur, S., Polglase, G., Pillow, J., Nitsos, I., Newnham, J., Chougnet, C., Kroon, E., Spierings, J., Willems, C., Jobe, A., Kramer, B., 2011, IL-1alpha mediated chorioamnionitis induces depletion of FoxP3+ cells and ileal inflammation in the ovine fetal gut, PLoS ONE [P], vol 6, issue 3 (Art. No: e18355), Public Library of Science, United States, pp. 1-9.
Hillman, N., Polglase, G., Pillow, J., Saito, M., Kallapur, S., Jobe, A., 2011, Inflammation and lung maturation from stretch injury in preterm fetal sheep, American Journal Of Physiology-Lung Cellular And Molecular Physiology [P], vol 300, issue 2, American Physiological Society, United States, pp. L232-L241.
Berry, C., Nitsos, I., Hillman, N., Pillow, J.J., Polglase, G., Kramer, B., Kemp, M., Newnham, J., Jobe, A., Kallapur, S., 2011, Interleukin -1 in lipopolysaccharide induced chorioamnionitis in the fetal sheep, Reproductive Sciences [P], vol 18, issue 11, Sage Publications Inc, USA, pp. 1092-1102.
Kallapur, S., Kramer, B., Nitsos, I., Pillow, J., Collins, J., Polglase, G., Newnham, J., Jobe, A., 2011, Pulmonary and systemic inflammatory responses to intraamniotic IL-1alpha in fetal sheep, American Journal Of Physiology-Lung Cellular And Molecular Physiology [P], vol 301, issue 3, American Physiological Society, United States, pp. L285-L295.
Andersen, C., Pillow, J., Gill, A., Allison, B., Moss, T., Hooper, S., Nitsos, I., Kluckow, M., Polglase, G., 2011, The cerebral critical oxygen threshold of ventilated preterm lambs and the influence of antenatal inflammation, Journal of Applied Physiology Respiratory Environmental and Exercise Physiology [P], vol 111, issue 3, American Physiological Society, United States, pp. 775-781.
Pillow, J., Musk, G., McLean, C., Polglase, G., Dalton, R., Jobe, A., Suki, B., 2011, Variable ventilation improves ventilation and lung compliance in preterm lambs, Intensive Care Medicine [P], vol 37, issue 8, Springer, Germany, pp. 1352-1359.
Hillman, N., Kallapur, S., Pillow, J., Moss, T., Polglase, G., Nitsos, I., Jobe, A., 2010, Airway injury from initiating ventilation in preterm sheep, Pediatric Research [P], vol 67, issue 1, Lippincott Williams & Wilkins, United States, pp. 60-65.
Ball, M., Hillman, N., Kallapur, S., Polglase, G., Jobe, A., Pillow, J., 2010, Body temperature effects on lung injury in ventilated preterm lambs, Resuscitation [P], vol 81, issue 6, Elsevier Ireland Ltd, Ireland, pp. 749-754.
Collins, J., Kallapur, S., Knox, C., Nitsos, I., Polglase, G., Pillow, J., Kuypers, E., Newnham, J., Jobe, A., Kramer, B., 2010, Inflammation in fetal sheep from intra-amniotic injection of Ureaplasma parvum, American Journal Of Physiology-Lung Cellular And Molecular Physiology [P], vol 299, issue 6, American Physiological Society, United States, pp. L852-L860.
Hillman, N., Kallapur, S., Pillow, J., Nitsos, I., Polglase, G., Ikegami, M., Jobe, A., 2010, Inhibitors of inflammation and endogenous surfactant pool size as modulators of lung injury with initiation of ventilation in preterm sheep, Respiratory Research [P], vol 11, issue 151, BioMed Central Ltd, United Kingdom, pp. 1-8.
Polglase, G., Hooper, S.B., Gill, A.W., Allison, B.J., Crossley, K.J., Moss, T.J.M., Nitsos, I., Pillow, J.J., Kluckow, M., 2010, Intrauterine inflammation causes pulmonary hypertension and cardiovascular sequelae in preterm lambs, Journal Of Applied Physiology [P], vol 108, issue 6, American Physiological Society, USA, pp. 1757-1765.
Kramer, B.W., Kallapur, S.G., Moss, T.J.M., Nitsos, I., Polglase, G.P., Newnham, J.P., Jobe, A.H., 2010, Modulation of fetal inflammatory response on exposure to lipopolysaccharide by chorioamnion, lung, or gut in sheep, American Journal Of Obstetrics And Gynecology [P], vol 202, issue 1, Mosby Inc, USA, pp. 77.e1-77.e9.
Shah, T., Hillman, N., Nitsos, I., Polglase, G., Pillow, J., Newnham, J., Jobe, A., Kallapur, S., 2010, Pulmonary and systemic expression of monocyte chemotactic proteins in preterm sheep fetuses exposed to lipopolysaccharide-induced chorioamnionitis, Pediatric Research [P], vol 68, issue 3, Lippincott Williams & Wilkins, United States, pp. 210-215.
Allison, B.J., Crossley, K.J., Flecknoe, S.J., Morley, C.J., Polglase, G.R., Hooper, S.B., 2010, Pulmonary hemodynamic responses to in utero ventilation in very immature fetal sheep, Respiratory Research [P], vol 11, issue 1 (Art. No. 111), BioMed Central Ltd, UK, pp. 1-11.
Polglase, G., Dalton, R., Nitsos, I., Knox, C., Pillow, J., Jobe, A., Moss, T., Newnham, J., Kallapur, S., 2010, Pulmonary vascular and alveolar development in preterm lambs chronically colonized with Ureaplasma parvum, American Journal Of Physiology-Lung Cellular And Molecular Physiology [P], vol 299, issue 2, American Physiological Society, United States, pp. L232-L241.
Polglase, G., Hillman, N., Pillow, J., Nitsos, I., Newnham, J., Knox, C., Kallapur, S., Jobe, A., 2010, Ventilation-mediated injury after preterm delivery of Ureaplasma parvum colonized fetal lambs, Pediatric Research [P], vol 67, issue 6, Lippincott Williams & Wilkins, United States, pp. 630-635.
Cheah, F., Pillow, J., Kramer, B., Polglase, G., Nitsos, I., Newnham, J., Jobe, A., Kallapur, S., 2009, Airway inflammatory cell responses to intra-amniotic lipopolysaccharide in a sheep model of chorioamnionitis, American Journal Of Physiology-Lung Cellular And Molecular Physiology [P], vol 296, issue 3, American Physiological Society, United States, pp. 384-393.
Hillman, N., Pillow, J., Ball, M., Polglase, G., Kallapur, S., Jobe, A., 2009, Antenatal and postnatal corticosteroid and resuscitation induced lung injury in preterm sheep, Respiratory Research [P], vol 10, issue Art.No 124, BioMed Central Ltd., United Kingdom, pp. 1-11.
Crossley, K.J., Morley, C.J., Allison, B.J., Davis, P.G., Polglase, G.R., Wallace, M.J., Zahra, V.A., Hooper, S.B., 2009, Antenatal corticosteroids increase fetal, but not postnatal, pulmonary blood flow in sheep, Pediatric Research [P], vol 66, issue 3, Lippincott Williams & Wilkins, USA, pp. 283-288.
Jobe, A.H., Nitsos, I., Pillow, J.J., Polglase, G., Kallapur, S.G., Newnham, J.P., 2009, Betamethasone dose and formulation for induced lung maturation in fetal sheep, American Journal Of Obstetrics And Gynecology [P], vol 201, issue 6, Mosby Inc, USA, pp. 611.e1-611.e7.
Polglase, G.R., Hooper, S.B., Gill, A.W., Allison, B.J., McLean, C.J., Nitsos, I., Pillow, J.J., Kluckow, M., 2009, Cardiovascular and pulmonary consequences of airway recruitment in preterm lambs, Journal of Applied Physiology, vol 106, issue 4, American Physiological Society, USA, pp. 1347-1355.
Crossley, K.J., Allison, B.J., Polglase, G.R., Morley, C.J., Davis, P.G., Hooper, S.B., 2009, Dynamic changes in the direction of blood flow through the ductus arteriosus at birth, Journal Of Physiology-London [P], vol 587, issue Pt. 19, Wiley-Blackwell Publishing Ltd., UK, pp. 4695-4704.
Braun, T., Li, S., Sloboda, D., Li, W., Audette, M.C., Moss, T.J.M., Matthews, S.G., Polglase, G.R., Nitsos, I., Newnham, J.P., Challis, J.R.G., 2009, Effects of maternal dexamethasone treatment in early pregnancy on pituitary-adrenal axis in fetal sheep, Endocrinology [P], vol 150, issue 12, The Endocrine Society, USA, pp. 5466-5477.
Schulzke, S.M., Polglase, G.R., Sozo, F., Pillow, J.J., 2009, Feasibility and short-term effects of biphasic positive airway pressure versus assist-control ventilation in preterm lambs, Pediatric Research [P], vol 66, issue 6, Lippincott Williams & Wilkins, USA, pp. 665-670.
Ball, M., Jobe, A., Polglase, G., Kallapur, S., Cheah, F., Hillman, N., Pillow, J., 2009, High and low body temperature during the initiation of ventilation for near-term lambs, Resuscitation [P], vol 80, issue 1, Elsevier Ireland Ltd, Ireland, pp. 133-137.
Kallapur, S.G., Nitsos, I., Moss, T.J.M., Polglase, G.R., Pillow, J.J., Cheah, F., Kramer, B.W., Newnham, J.P., Ikegami, M., Jobe, A.H., 2009, IL-1 mediates pulmonary and systemic inflammatory responses to chorioamnionitis induced by lipopolysaccharide, American Journal Of Respiratory And Critical Care M..., vol 179, issue 10, American Thoracic Society, USA, pp. 955-961.
Polglase, G., Hillman, N., Ball, M., Kramer, B., Kallapur, S., Jobe, A., Pillow, J., 2009, Lung and systemic inflammation in preterm lambs on continuous positive airway pressure or conventional ventilation, Pediatric Research [P], vol 65, issue 1, Lippincott Williams & Wilkins, United States, pp. 67-71.
Pillow, J.J., Hillman, N.H., Polglase, G.R., Moss, T.J.M., Kallapur, S.G., Cheah, F., Kramer, B.W., Jobe, A.H., 2009, Oxygen, temperature and humidity of inspired gases and their influences on airway and lung tissue in near-term lambs, Intensive Care Medicine [P], vol 35, issue 12, Springer, Germany, pp. 2157-2163.
Moss, T.J.M., Nitsos, I., Knox, C.L., Polglase, G.R., Kallapur, S.G., Ikegami, M., Jobe, A.H., Newnham, J.P., 2009, Ureaplasma colonization of amniotic fluid and efficacy of antenatal corticosteroids for preterm lung maturation in sheep, American Journal of Obstetrics and Gynecology, vol 200, issue 1, Mosby, Inc., USA, pp. 96.e1-96.e6.
Polglase, G.R., Moss, T., Nitsos, I., Allison, B.J., Pillow, J.J., Hooper, S.B., 2008, Differential effect of recruitment maneuvres on pulmonary blood flow and oxygenation during HFOV in preterm lambs, Journal of Applied Physiology, vol 105, issue 2, American Physiological Society, United States, pp. 603-610.
Polglase, G.R., Hillman, N.H., Pillow, J.J., Cheah, F., Nitsos, I., Moss, T., Kramer, B.W., Ikegami, M., Kallapur, S.G., Jobe, A.H., 2008, Positive end-expiratory pressure and tidal volume during initial ventilation of preterm lambs, Pediatric Research, vol 64, issue 5, Lippincott Williams & Wilkins, United States, pp. 517-522.
Crossley, K.J., Morley, C.J., Allison, B.J., Polglase, G.R., Dargaville, P.A., Harding, R., Hooper, S.B., 2007, Blood gases and pulmonary blood flow during resuscitation of very preterm lambs treated with antenatal betamethasone and/or curosurf: Effect of positive end-expiratory pressure, Pediatric Reseaarch, vol 62, issue 1, Int Pediatric Research Foundation Inc, Baltimore MD USA, pp. 37-42.
Hillman, N., Moss, T., Kallapur, S., Bachurski, C., Pillow, J., Polglase, G., Nitsos, I., Kramer, B., Jobe, A., 2007, Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep, American Journal Of Respiratory And Critical Care Medicine [P], vol 176, issue 6, American Thoracic Society, United States, pp. 575-581.
Pillow, J., Hillman, N., Moss, T., Polglase, G., Bold, G., Beaumont, C., Ikegami, M., Jobe, A., 2007, Bubble continuous positive airway pressure enhances lung volume and gas exchange in preterm lambs, American Journal Of Respiratory And Critical Care Medicine [P], vol 176, issue 1, American Thoracic Society, United States, pp. 63-69.
Polglase, G., Nitsos, I., Jobe, A., Newnham, J., Moss, T., 2007, Maternal and intra-amniotic corticosteroid effects on lung morphometry in preterm lambs, Pediatric Research [P], vol 62, issue 1, Lippincott Williams & Wilkins, United States, pp. 32-36.
Polglase, G.R., Wallace, M.J., Morgan, D.L., Hooper, S.B., 2006, Increases in lung expansion alter pulmonary hemodynamics in fetal sheep, Journal of Applied Physiology, vol 101, issue 1, American Physiology Society, Bethesda USA, pp. 273-282.
Polglase, G.R., Hooper, S.B., 2006, Role of intra-luminal pressure in regulating PBF in the fetus and after birth, Current Pediatric Reviews, vol 2, issue 4, Benthan Science Publishers Ltd, Netherlands, pp. 287-299.
Wallace, M.J., Thiel, A.M., Lines, A.M., Polglase, G., Sozo, F., Hooper, S.B., 2006, Role of platelet-derived growth factor-B, vascular endothelial growth factor, insulin-like growth factor-II, mitogen-activated protein kinase and transforming growth factor-beta1 in expansion-induced lung growth in fetal sheep, Reproduction, Fertility and Development, vol 18, issue 6, CSIRO, Australia, pp. 655-665.
Polglase, G.R., Morley, C.J., Crossley, K.J., Dargaville, P.A., Harding, R., Morgan, D.L., Hooper, S.B., 2005, Positive end-expiratory pressure differentially alters pulmonary hemodynamics and oxygenation in ventilated, very premature lambs, Journal of Applied Physiology, vol 99, issue 4, American Physiological Society, Bethesda USA, pp. 1453-1461.
Polglase, G.R., Wallace, M.J., Grant, D.A., Hooper, S.B., 2004, Influence of fetal breathing movements on pulmonary hemodynamics in fetal sheep, Pediatric Research, vol 56, issue 6, International Pediatric Research Foundation, Inc., Baltimore USA, pp. 932-938.
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