Perinatal Research Centre

Brain

The ultimate goal of the Brain Research Group is to develop therapies which will minimise neurological injury and improve infant outcome through a better understanding of the mechanisms of cell injury and death.

A severe hypoxic/ischemic insult to the developing infant brain carries with it a high risk of neurological disability and in some cases death. In Australia approximately 3.5% of all perinatal deaths are due to asphyxia. The development of neural rescue therapies will result in less disabilities. However the opportunity to improve long-term outcome may only last 12 to 24 hours following a hypoxic insult. It is therefore necessary to rapidly identify infants at risk of a poor neurodevelopmental outcome so that potential benefits of neural rescue therapies can be maximised. Currently there is no technique available which can accurately identify these infants within the required time period. We have several projects aimed at finding the neccessary new techniques.

The numerous physiological and biochemical events that arise as a consequence of oxygen and glucose deprivation in hypoxia-ischemia, offer the potential for reducing neurological damage through interruption or possibly termination of neuronal cell death. In order to develop a clinical strategy to manage hypoxic-ischemic disease successfully, a greater understanding is needed of the complex processes which underlie hypoxic-ischemic neuronal pathology and dysfunction.

Current research interests of the PRC Brain Research Group include:

• Neuroprotection - including hypothermia and the use of pharmacological agents as a rescue therapy
• Neonatal seizures - detection and treatment
• Mechanisms of HI brain injury - inflammation and excitotoxicity
• Brain injury in the intrauterine growth restricted neonate
• Effects of nutrition and the environment on preterm brain development
• Tracking preterm brain development with magnetic resonance imaging (MRI) and EEG
• Fetal alcohol spectrum disorders (FASD)

With research driven from different perspectives focused on a better understanding of the mechanisms of cell injury, death and repair, our ultimate goal is to develop therapies to improve infant outcomes. 

Clinical trials

The Clinical Trials Unit (CTU) provides and maintains a sophisticated, efficient and internationally recognised quality perinatal clinical trials service with the RBWH. The unit is active in collaborative and original clinical research. Evidence based practice is key in modern healthcare. The Cochrane Collaboration is a repository of the highest quality evidence underpinning health care practices. The PRC is active in contributing to this collaboration across a variety of areas of expertise that encompass all the PRC groups. Protocols are developed and published with regular updates provided through systematic review of published material. Systematic reviews are utilised by health policy makers, clinicians, researchers and consumers to stay abreast of findings and provide the highest quality health care.

Current clinical trials

• A Study of the Impact of Treating Electrographic Seizures in Term or Near-Term Infants with Neonatal Encephalopathy (NEST).
• High-flow Nasal Cannulae as Post-extubation Respiratory Support in Premature Infants:  A CPAP Equivalent? (The HIPERSPACE Trial)
• PREBO Preterm Brain Outcomes– The aim of this project is to predict neurodevelopmental disability in babies born very preterm, earlier and more accurately than currently possible.
• PREBO-6 – nPrediction of childhood brain outcomes in infants born preterm using neonatal MRI and concurrent clinical biomarkers
• PEACH - Is early accumulation of fat and reduction in fat free mass in preterm infants associated with adverse cognitive or metabolic outcomes in childhood?
• Is ibuprofen associated with neuroprotection in the SGA infant? Neurodevelopmental outcomes at 2 years following ibuprofen treatment for patent ductus arteriosus in the preterm small for gestational age newborn: potential for neuroprotection

Signal processing

The signal processing research and consultancy group (SPRC) undertakes fundamental research in time-frequency signal processing with biomedical applications, with particular application to neonatal seizure treatment and prevention, fetal movement detection and generally improving health outcomes.

Research activities

Development of time-frequency signal processing algorithms and techniques

• Design of reduced interference time-frequency distributions
• Algorithm design for the implementation of discrete time-frequency distributions
• Classification  of nonstationary signals in time-frequency and Doppler-lag domains
• Time-frequency array processing of multichannel data
• Design of optimal time-frequency matched filters
• Algorithms for instantaneous frequency estimation

Time Frequency Signal Analysis (TFSA) Matlab Toolbox

Biomedical applications

• Analysis of newborn EEG for abnormality detection and classification
  • Diagnostic and prognostic analysis of background and interictal EEG abnormalities
  • Newborn EEG seizure detection
• Newborn EEG source localization
• Multivariate brain connectivity analysis
• Fetal movement detection
• Data acquisition and labelling
• Preprocessing of biological signals for noise and artifact removal

Systems physiology

The Systems Physiology Research Group comprises two inter-related areas - body composition and preterm cardiovascular function. Dr Yvonne Eiby and Dr Barbara Lingwood are investigating the unique cardiovascular physiology of preterm neonates in order to rationally develop novel therapeutic strategies to improve cardiovascular function, and thus protect the developing brain. Dr Lingwood, Dr Eiby and A/Prof Donovan are also studying body composition in neonates with the aim of optimising nutrition and growth of infants in order to improve brain outcomes and reduce cardiometabolic risk.