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Research outline - Grace Newborn Care

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Research program

Outcomes of neonatal surgery

Babies are now surviving after extremely complex surgery which is being undertaken at earlier ages and at smaller birth weights. However, surprisingly little is known about their long term quality of life. This has prompted us to enrol neonates who have had major surgery in a unique developmental follow-up study (The Daisy Study) which was funded by the March of Dimes Birth Defects Foundation in the USA. This unique research study focuses on the outcome for infants and their families following major surgery. As survival improves, the outcome of surgery in infancy affects a significant number of children and an every growing number of adults. Our research addresses the effects of infant surgery, with relevance to individual counselling and in the long term, population health.

Families who have had an infant who undergoes neonatal surgery are faced with many challenges as they prepare to take their child home. This led us to undertake a study examining the social and emotional burden of having an infant who requires neonatal surgery. This study has been supported by an Australian Research Council (ARC) grant and is being undertaken in collaboration with the University of Melbourne and Royal Children's Hospital. Our goal of supporting families has led to a study of post traumatic stress in parents who have a baby in intensive care and following discharge.

Often babies in the NICU are exposed to many potentially painful procedures and pain as a result of neonatal surgery. As we strive for the optimal management of pain studies have explored the use of assessment and management practices. We are part of a national project to close the evidence/practice gap for pain management practices in the post-operative period. As part of a national project a study was undertaken with the aim to obtain information on the practices and beliefs of junior doctors regarding neonatal pain and to compare this to best evidence. We are currently mapping the pain management practices and applying current evidence to support best practice.

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Developing a culture of nurses and research

Nurses provide expert clinical care and as part of our research philosophy we support the integration of research into practice. A study examining nursing knowledge on patient outcomes and decision making is a collaborative project with all the NICUs in NSW. The study is supported by several seeding grants. The Clinical Neonatal Nursing Research Fellowship was established 5 years ago and continues to provide opportunities for a clinical nurse to undertake a small study and gain an understanding of the research process. The current incumbent is undertaking a RCT of a new device for securing end-tracheal tubes in ventilated infants. Two nursing honours students are undertaking studies looking at research utilisation in two NICUs.

Premature Lung Disease

There has been an increasing survival of preterm infants but despite this many of them still suffer from long term respiratory problems, such as the development of Chronic Lung Disease (CLD). There is growing research to suggest that an imbalance of inflammation contributes to CLD in preterm infants and that the production of the anti-inflammatory protein, Clara Cell Secretory Protein (CCSP), is directly related to newborn pulmonary protection. Given that the production of CCSP increases during gestation, preterm infants tend to have a relative deficiency of CCSP, thereby putting them at risk of developing CLD. We are studying the behaviour of CCSP in newborn infants to hopefully contribute to future prevention of neonatal CLD. This study has been conducted in conjunction with the Department of Newborn Care, Royal Hospital for Women, Randwick, the Leslie Stevens Newborn Research Laboratory, RHW, Randwick and the University of NSW, and is supported by grants from the Leslie Stevens Fund for Newborn Care, Sydney Children's Hospital Foundation.

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Neonatal ultrasound in transport (NUIT study)

Many infants who require intensive care are born in peripheral hospitals with previously undiagnosed conditions. The NUIT study is assessing the role of diagnostic ultrasound prior to transport in contributing to earlier institution of life saving therapy as well as transfer to the most appropriate intensive care unit.

Collaborative Research programs

Studies of term cerebral palsy

The incidence of cerebral palsy remains unchanged in term infants despite improvements in antenatal and perinatal care. We have been carrying out population-based research in the area of newborn encephalopathy and cerebral palsy for over 10 years in collaboration with the Telethon Institute for Child Health Research.

Neonatal Intensive Care Units Study (NICUS)

Increasing clinical co-operation between the Neonatal Intensive Care Units within New South Wales and the ACT has highlighted the need for timely high quality clinical audit data. Our unit is playing a lead role in the re-development of the technology and methodology that will enhance the measurement and reporting of key clinical outcomes for the region as well as provide a rich data set to aid in epidemiological research.

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Research support (2008/09)

NH&MRC

ARC grant with University of Melbourne and Royal Children's Hospital, Melbourne

March of Dimes

Leslie Stevens Fund

Australian College of Neonatal Nursing

CHW Nurses Scholarship

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