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Perth, Australia

Song Y.,University of Western Australia | Jane Pillow J.,University of Western Australia | Jane Pillow J.,Neonatal Clinical Care Unit
Anatomical Record | Year: 2012

Although upregulation of protein degradation pathways contributes to the development of muscle weakness in response to muscle injury and inflammation in the adult diaphragm, less is known about the preterm diaphragm. Muscle development during the antenatal and early postnatal periods normally results in net growth. However, the structural and functional immaturity of the preterm diaphragm may predispose it to injury and inflammation induced by adverse antenatal and postnatal exposures. Characterization of the ontogeny of diaphragm protein degradation pathways in early life is essential to recognize altered signaling pathways under pathologic conditions in preterm babies. We assessed the relative role of the major proteolytic pathways and antioxidant capacity during muscle maturation in ovine fetuses and lambs from 75 days to 200 days postconceptual age. Gene expression and protein content of calpain and caspase 3 exhibited a similar profile with advancing gestation, increasing from 75 days to 100 days/128 days and subsequently decreasing gradually toward the end of gestation. In contrast, ubiquitin conjugating and ligase genes did not change during gestation. All proteolytic genes examined (except Ubiquitin) were upregulated rapidly after delivery, with a similar developmental trend observed in calpain II protein content as well as calpain protease activity. In contrast, antioxidant gene expression demonstrated a steady increase from 75 days gestation to 24 hr after birth, followed by a significant reduction at 7 weeks of postnatal age (P ≤ 0.002). The proteolytic signaling and antioxidant capacity patterns reflect the adaptive process to metabolic change and muscle maturity with development. © 2012 Wiley Periodicals, Inc.

Jane Pillow J.,University of Western Australia | Jane Pillow J.,Neonatal Clinical Care Unit
Clinics in Perinatology | Year: 2012

Various commercial and home-made continuous positive airway pressure (CPAP) systems are described in this article. CPAP may be delivered via a range of device-patient interfaces; nasal CPAP is most common, and short binasal prongs impose the least extrinsic load impedance on the infant. The source of pressure generation is categorized as either constant pressure or constant flow. The efficacy of different systems may vary according to whether lung volume recruitment, airway patency, minimization of work of breathing, or central nervous system stimulation are the primary goal of the clinical decision to use CPAP therapy. © 2012 Elsevier Inc.

Czank C.,University of Western Australia | Simmer K.,Neonatal Clinical Care Unit | Hartmann P.E.,University of Western Australia
Breastfeeding Medicine | Year: 2010

Background: It is necessary to fortify human milk to promote optimal growth of the very preterm infant. However, the addition of non-human milk components to human milk is not ideal because of the risk of feeding intolerance and necrotizing enterocolitis. Human milk products (HMP) are an alternative to commercially available fortifiers, but their preparation is likely to result in modifications to the qualities of human milk. Methods: Ten batches of HMP were prepared with the aim of meeting a desired protein:energy ratio of 3.0g of protein/100kcal. Ultrafiltration was used to produce a skim milk concentrate, to which cream was then added to produce the final HMP. Characterization of HMP and human milk fortified with commercial human milk fortifiers (Nutriprem® [Cow & Gate, Limerick, Ireland] and S-26 SMA human milk fortifier [Wyeth Nutrition, Baulkham Hills, NSW, Australia]) included quantifying macronutrient content, osmolality, microbial content, and particle distribution. Results: Average protein:energy ratio of the final batch was 2.93±0.10g of protein/100kcal, equating to an inaccuracy of 2.5% relative to the desired ratio of 3.0g of protein/100kcal. Significantly greater fat (P<0.01), lower lactose (P<0.001), and lower osmolality (P<0.001) were characteristic of the HMP compared to human milk fortified with either commercial fortifier. Microbial growth occurred during preparation of HMP but did not exceed 10 5 colony-forming units/mL, and pasteurization of human milk prevented contamination in 80% of batches. Conclusions: HMP can be designed to accurately target the protein and energy requirements of the preterm infant, but modifications of the macronutrient, biochemical, structural, and microbial characteristics of human milk may affect the quality of the final product. © 2010, Mary Ann Liebert, Inc.

French N.,Neonatal Clinical Care Unit | French N.,State Child Development Center | French N.,Center for Neonatal Research and Education | Kelly R.,State Child Development Center | And 6 more authors.
Pediatrics | Year: 2013

Background and Objectives: Voice abnormality is a frequent finding in school age children born at <25 weeks' gestation in Western Australia. The objective of this study was to determine the frequency of voice abnormality, voice-related quality of life, and demographic and intubation factors in this population. Methods: Survivors <25 weeks' gestational age in Western Australia born from 1996 to 2004 were included. Voice assessments (auditory perceptual assessment scale and Pediatric Voice Handicap Index) were carried out by speech pathologists. Intubation history was obtained by retrospective chart review. Results: Of 251 NICU admissions, 154 (61%) survived. Exclusions were based on severe disability (11) or distant residence (13). Of 70 assessed, 67 completed assessments, 4 (6%) were in the normal range and 39 (58%) showed moderate-severe hoarseness. Simultaneous modeling of demographic and intubation characteristics showed an increased odds of moderate-severe voice disorder for children who had more than 5 intubations (odds ratio 6.96, 95% confidence interval 2.07-23.40, P = .002) and for girls relative to boys (odds ratio 3.46, 95% confidence interval 1.12-10.62, P = .030). Tube size and duration of intubation were not significant in the multivariable model. Median scores of parent-reported voice quality of life on the Pediatric Voice Handicap Index were markedly different for preterm (22) and term (3) groups, P < .001. Conclusions: Voice disorders in this population were much more frequent than expected. Further studies are required to assess voice across a broader range of gestational ages, and to investigate voiceprotective strategies in infants requiring multiple episodes of intubation. Copyright © 2013 by the American Academy of Pediatrics.

Strunk T.,University of Western Australia | Strunk T.,Neonatal Clinical Care Unit | Inder T.,Washington University in St. Louis | Wang X.,Gothenburg University | And 6 more authors.
The Lancet Infectious Diseases | Year: 2014

Preterm birth and infectious diseases are the most common causes of neonatal and early childhood deaths worldwide. The rates of preterm birth have increased over recent decades and account for 11% of all births worldwide. Preterm infants are at significant risk of severe infection in early life and throughout childhood. Bacteraemia, inflammation, or both during the neonatal period in preterm infants is associated with adverse outcomes, including death, chronic lung disease, and neurodevelopmental impairment. Recent studies suggest that bacteraemia could trigger cerebral injury even without penetration of viable bacteria into the CNS. Here we review available evidence that supports the concept of a strong association between bacteraemia, inflammation, and cerebral injury in preterm infants, with an emphasis on the underlying biological mechanisms, clinical correlates, and translational opportunities. © 2014 Elsevier Ltd.

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