Newborn Research

The Department of Paediatrics hosts one of the largest perinatal research clusters in Australia, together with local partners, which include The Ritchie Centre at Hudson Institute of Medical Research, Monash Children's Hospital and several Faculties and Schools of Monash University. The spectrum of the cutting-edge research we conduct ranges from biomedical and physiological discovery research to early phase clinical trials and covers a wide variety of fields (see links below). To achieve our ambitious academic and translational goals, we utilise modern, purpose-built facilities at the Monash Health Translation Precinct and their excellently equipped core facilities.

Researchers

Staff and students View

Research groups

Neurology, Neuro-development & Follow-Up View

At Monash Newborn, medical, nursing and allied health staff are actively involved in clinical and preclinical research in neurology, neurodevelopment and neuroprotection to identify new ways to improve the care and outcome of the babies we look after. These are in association with our colleagues at The Ritchie Centre, Hudson Institute of Medical Research, as well as other local and international collaborators. All high risk infants, and any infant with proven brain injury are followed up using standardised assessment tools in the early neurodevelopment, and long term developmental follow up clinics. We have a particular focus on early detection and intervention of cerebral palsy, and work closely with Monash Children's Hospital allied health teams and the Victorian Paediatric Rehabilitation Service.

Research streams

Neonatal Brain Protection View

Neuro development and Neuroprotection View

The Neurodevelopment and Neuroprotection research group is embedded within the Fetal and Neonatal Health Neurodevelopment and Brain Injury Theme of The Ritchie Centre, and is closely affiliated with the Cell Therapy and Regenerative Medicine Theme led by Professor Graham Jenkin. The group provides a focus for experimental and clinical studies directed towards understanding, and inhibiting, the mechanisms that contribute to perinatal brain injury and functional deficits associated with cerebral palsy. We strive towards the implementation of treatments to decrease neonatal brain injury and that can be effectively administered either during pregnancy or in the neonatal period. Such treatments include antioxidants, anti-inflammatory agents, and stem cells obtained from the cord blood and placenta.

Professor Suzie Miller’s group comprises more than 20 members with experts in fetal physiology, neuroscience, stem cells, cardiovascular physiology, clinical obstetrics, neonatology and paediatrics. This group provides a highly-regarded training platform for biomedical and clinical students.

Meet the team View

Research Projects

Stem cells to reduce perinatal brain injury – fact or fiction?
Protecting the intrauterine growth restricted (IUGR) fetal brain with natural neurosteroids.
Treating neonatal seizures with ganaxolone
Can we modify neurovascular development in the IUGR brain with endothelial progenitor stem cells derived from cord blood?
Umbilical cord blood stem cells to improve brain structure and function after severe birth asphyxia, when to administer and how many?
Improving newborn wellbeing in a rural Indian community with a simple transdermal patch.

Perinatal Inflammation and Neurophysiology View

Too much inflammation during pregnancy or shortly after birth is a fundamental process that contributes to impaired newborn brain development and function and can result in life-long disorders in movement, cognition, hearing and vision. Our team focuses on discovering the cellular and physiological pathways that underpin how inflammation impairs brain cell development and function, and studies how existing and new anti-inflammatory interventions could help restore healthy brain development. To achieve this, we use a highly integrated and multidisciplinary approach that includes preclinical models of developmental brain injury, fundamental neuroscience, electrophysiology, medical imaging and assessment of clinical samples. Through collaborative partnerships with clinical experts, academia and industry, we are developing new and improved compounds for the treatment of newborn brain injury; and developing physiological biomarkers and brain imaging technology to improve the sensitivity and specificity of brain injury detection for improved treatment outcomes.

We are accepting graduate student applications (Honours / Masters / PhD). For enquiries, please contact Dr Robert Galinsky on Robert.Galinsky@monash.edu

Meet the team View

Interventional Immunology for Early Life Disease View

2019 Interventional Immunology group L-R: Kneeling: Esteban Pinto, Nick Johnson, Elizabeth Skuza, Manjeet Sandhu Standing: Holly Ung, Rimma Goldberg, Abhilasha Tiwari, Nadia Deen, Jane Shi, Christine Bui, Michael Christie, Claudia Nold, Merrin Pang, Marcel Nold, Ina Rudloff, Philip Berger, Sonia John, Rebecka Atkinson

Researchers

G’day – and thank you for visiting our website.

I am an Australian-, German- and US-trained clinician-scientist with appointments as Professor of Paediatric Immunology at Monash University’s Department of Paediatrics, the Hudson Institute’s Ritchie Centre, and as Consultant Neonatal Paediatrician at Monash Newborn, Monash Children’s Hospital.

My lab is firmly rooted in biomedical discovery science; however, achieving true translation and thereby making a real difference to patients’ lives has been our paramount goal for the past 10 years. Hence, my team and I harness our expertise in immunology, anti-inflammatory cytokines, drug discovery and early life diseases to unveil molecular mechanisms underpinning these diseases, thus identifying and pursuing novel therapeutic avenues. Our discoveries, often collaborative efforts with Australian and international partners in academia as well as the pharmaceutical and biotech industries, have been very well received; for an overview click here.

The team and I highly value the contribution of students to our work, and my senior staff and I are strongly dedicated to providing outstanding training, supervision and mentoring. We offer a wide variety of projects – for some examples click here – and students with a passion for science are always welcome. If this is you, please be in touch!

- Exploring a new frontier: The immune and coagulation systems of the premature infant and their relevance for the risk of the major diseases of prematurity.
  Direct clinical relevance: high. Hands-on learning opportunities: Multi-color flow cytometry, protein arrays, cell culture of primary human blood cells.
- Molecular tracking of the cytokine IL-37 in anti-inflammatory signalling.
  Direct clinical relevance: medium/low. Hands-on learning opportunities: Confocal microscopy, molecular engineering (cloning), cell culture of primary human blood cells and cell lines.
- Novel anti-inflammatory approaches for currently untreatable diseases of the preterm baby: IL-1Ra and IL-37 in animal models of bronchopulmonary dysplasia and necrotising enterocolitis.
  Direct clinical relevance: high. Hands-on learning opportunities: Various aspects of work with mice, workup of tissues for various downstream applications, flow cytometry, histology, immunohistochemistry, protein detection by ELISA, synchrotron X-ray imaging.
- Molecular characterisation of regulation and mechanism of action of the anti-inflammatory cytokine interleukin 37.
  Direct clinical relevance: medium/low. Hands-on learning opportunities: Culture of primary human blood cells and cell lines, protein detection by ELISA, RNA detection by real-time PCR, flow cytometry, immunohistochemistry.
- The first in vivo exploration of IL-38.
  Direct clinical relevance: medium/low. Hands-on learning opportunities: Various aspects of work with mice, workup of tissues for various downstream applications, flow cytometry, histology, immunohistochemistry, protein detection by ELISA, RNA detection by real-time PCR.
- Nold MF et al, PNAS 2013, PubMed ID 23946428
  - In this paper, we show that IL-1Ra (interleukin 1 receptor antagonist), an endogenous anti-inflammatory mediator that has been available as a drug for ~25 years but has not been trialled in neonates, protects from the severe neonatal chronic lung disease BPD (bronchopulmonary dysplasia). Follow-on papers explore the best dosing strategy (PubMed ID 27957795), IL-1Ra’s effects on pulmonary hypertension (a severe complication of BPD, PubMed ID 31354700) and airway reactivity (PubMed ID 27482635). A clinical trial to substantiate IL-1Ra’s promise is in preparation.
1. Nold MF et al, Nature Immunology 2010, PubMed ID 20935647
2. Nold-Petry CA et al, Nature Immunology 2015, PubMed ID 25729923
  1. Here, we report the discovery of the function (paper 1 above), cell surface receptor and signalling (paper 2 above) of IL-37 (interleukin 37) an anti-inflammatory cytokine with exciting potential for use as a future medication for a wide spectrum of inflammatory diseases.
- Cho SX et al, Nature Communications 2020, PubMed ID 33188181
  - This paper is our first to publish on a large collaborative study conducted over 7 years in three of the tertiary neonatal centres in Melbourne and Victoria. We show that IL-37 holds promise as a future therapy for necrotising enterocolitis (NEC), a severe intestinal disease that affects newborn babies.
1. Bui et al, Journal of Reproductive Immunology 2017, PubMed ID 29035757
2. Cho et al, Expert Reviews in Molecular Medicine 2016, PubMed ID 27341512
  1. If you want to know a bit more about BPD (paper 1 above) and/or NEC (paper 2 above), have a look at reviews we have published on these topics; note that students substantially contributed to these papers and are first authors.

Cell Therapy View

Lung & Resuscitation View

Group Head

Dr Calum Roberts

Researchers

The Newborn Lung and Resuscitation Group in the Department of Paediatrics is a collaborative group of clinician-researchers working at Monash Children’s Hospital, and perinatal physiologists based at The Ritchie Centre. The members of our research group have specific interests in lung aeration, cord clamping, birth asphyxia, and later respiratory outcomes such as bronchopulmonary dysplasia. We aim to better understand the physiology of respiratory and resuscitation treatments in early life, and to translate this knowledge into improved outcomes for preterm and sick newborn infants.

Current projects

Surfactant is a life-saving medication for preterm infants with respiratory distress syndrome. Current methods of surfactant treatment are effective, but challenging to perform, which means that surfactant treatment is not possible in all hospitals caring for newborn infants. The SURFSUP Trial is investigating an easier and more generalisable way to give surfactant, using simple devices called supraglottic airways. The trial is led by the Monash Newborn Research team, and includes colleagues in Australia, New Zealand, Norway and the UK. SURFSUP is funded by the NHMRC, with additional support from Chiesi Pharmaceuti. If shown to be effective, SURFSUP will make surfactant treatment more accessible for many preterm babies born in a variety of healthcare settings.
Routine assessment of ‘gastric residual volume’ (checking what is in the stomach before feeding) is a common practice in many hospitals caring for preterm infants. However, other hospitals do not measure gastric residual volume when establishing feeding. It is not clear which approach is the best way to safely establish feeding in preterm babies. The neoGASTRIC Trial will compare these two approaches in more than 7,000 infants, to determine which is best. neoGASTRIC is a collaboration between Australian units, led by Monash Newborn, and UK units, led by the NPEU at Oxford University and Imperial College London, and is funded by the NHMRC and NIHR (UK).
Infants exposed to a lack of oxygen during or prior to birth (asphyxia) are at high risk of death or disability. Unfortunately, there is a lack of good-quality evidence to guide how best to assess and provide resuscitation treatment for these infants. Our group includes clinical neonatologists and leading physiologists from The Ritchie Centre, working in collaboration with clinical colleagues from Australia and Canada, to determine more effective ways of providing advanced resuscitation treatments such as chest compressions and adrenaline. This program of research has attracted funding from Heart Foundation Australia and the Cerebral Palsy Alliance.

Completed projects

The HIPSTER Trial compared two treatments for preterm infants requiring breathing support soon after birth: nasal High Flow, a newer, more comfortable and easy-to-use treatment, and continuous positive airway pressure (CPAP), the established treatment. CPAP was found to be the most effective treatment, but nasal High Flow could be used effectively in the majority of infants. The HIPSTER Trial influenced international guidelines on breathing support for preterm infants, and thousands of infants receive nasal High Flow treatment in Australia annually.
The majority of preterm infants are born in regional special care nurseries, rather than large metropolitan neonatal intensive units. The HUNTER Trial was the first trial to evaluate the use of nasal High Flow in special care nurseries, providing the evidence that this treatment was feasible in these units. Two of the nine participating study centres were Monash Newborn units: Casey Hospital and Dandenong Hospital.
Intubation (placement of a breathing tube into the airway) is a critical procedure for the sickest and most preterm infants, who require breathing support from a ventilator. The SHINE Trial showed that by applying nasal High Flow support during intubation, the procedure was more likely to be completed at the first attempt, and infants’ oxygen levels were more stable during the procedure.
‘Physiologically-based cord clamping’, involves the provision of breathing support with the umbilical cord intact, so that lung aeration is achieved before the cord is clamped. The BabyDUCC Trial assessed the use of this approach in a group of infants born at 32 weeks’ gestation and above, who needed breathing support at birth, showing it could be performed feasibly and safely. The BabyDUCC Trial also provided new data on normal reference ranges for heart rate and oxygen levels in infants receiving delayed cord clamping, who did not require resuscitation.

Selected publications

Roberts CT, Owen LS, Manley BJ, Frøisland DH, Donath SM, Dalziel KM, Pritchard MA, Cartwright DW, Collins CL, Malhotra A, Davis PG; for the HIPSTER Trial Investigators. Nasal High-Flow Therapy for Primary Respiratory Support in Preterm Infants. NEW ENGLAND JOURNAL OF MEDICINE 2016 Sep 22;375(12):1142-51. doi: 10.1056/NEJMoa1603694.

Manley BJ, Arnolda GRB, Wright IMR, Owen LS, Foster JP, Huang L, Roberts CT, Clark TL, Fan WQ, Fang AYW, Marshall IR, Pszczola RJ, Davis PG, Buckmaster AG; HUNTER Trial Investigators. Nasal High-Flow Therapy for Newborn Infants in Special Care Nurseries. NEW ENGLAND JOURNAL OF MEDICINE 2019 May 23;380(21):2031-2040. doi: 10.1056/NEJMoa1812077.

Hodgson KA, Owen LS, Kamlin COF, Roberts CT, Newman SE, Francis KL, Donath SM, Davis PG, Manley BJ. Nasal High-Flow Therapy during Neonatal Endotracheal Intubation. NEW ENGLAND JOURNAL OF MEDICINE 2022 Apr 28;386(17):1627-1637. doi: 10.1056/NEJMoa2116735.

Badurdeen S, Davis PG, Hooper SB, Donath S, Santomartino GA, Heng A, Zannino D, Hoq M, Omar F Kamlin C, Kane SC, Woodward A, Roberts CT, Polglase GR, Blank DA; Baby Directed Umbilical Cord Clamping (BabyDUCC) collaborative group. Physiologically based cord clamping for infants ≥32+0 weeks gestation: A randomised clinical trial and reference percentiles for heart rate and oxygen saturation for infants ≥35+0 weeks gestation. PLoS MEDICINE 2022 Jun 23;19(6):e1004029. doi: 10.1371/journal.pmed.1004029.

Roberts CT, Halibullah I, Bhatia R, Green EA, Kamlin COF, Davis PG, Manley BJ. Outcomes after Introduction of Minimally Invasive Surfactant Therapy in Two Australian Tertiary Neonatal Units. JOURNAL OF PEDIATRICS 2021 Feb;229:141-146. doi: 10.1016/j.jpeds.2020.10.025. Epub 2020 Oct 14.

Green EA, Dawson JA, Davis PG, De Paoli AG, Roberts CT. Assessment of resistance of nasal continuous positive airway pressure interfaces. ARCHIVES OF DISEASE IN CHILDHOOD FETAL AND NEONATAL EDITION 2019 Sep;104(5):F535-F539. doi: 10.1136/archdischild-2018-315838. Epub 2018 Dec 19. PMID: 30567774

Blank DA, Polglase GR, Kluckow M, Gill AW, Crossley KJ, Moxham A, Rodgers K, Zahra V, Inocencio I, Stenning F, LaRosa DA, Davis PG, Hooper SB. Haemodynamic effects of umbilical cord milking in premature sheep during the neonatal transition. ARCHIVES OF DISEASE IN CHILDHOOD FETAL AND NEONATAL EDITION 2018 Nov;103(6):F539-F546. doi: 10.1136/archdischild-2017-314005. Epub 2017 Dec 5. PMID: 29208663; PMCID: PMC6278653.

Roberts CT, Klink S, Schmölzer GM, Blank DA, Badurdeen S, Crossley KJ, Rodgers K, Zahra V, Moxham A, Roehr CC, Kluckow M, Gill AW, Hooper SB, Polglase GR. Comparison of intraosseous and intravenous epinephrine administration during resuscitation of asphyxiated newborn lambs. ARCHIVES OF DISEASE IN CHILDHOOD FETAL AND NEONATAL EDITION 2022 May;107(3):311-316. doi: 10.1136/archdischild-2021-322638. Epub 2021 Aug 30.

Polglase GR, Schmölzer GM, Roberts CT, Blank DA, Badurdeen S, Crossley KJ, Miller SL, Stojanovska V, Galinsky R, Kluckow M, Gill AW, Hooper SB. Cardiopulmonary Resuscitation of Asystolic Newborn Lambs Prior to Umbilical Cord Clamping; the Timing of Cord Clamping Matters! FRONTIERS IN PHYSIOLOGY 2020 Jul 30;11:902. doi: 10.3389/fphys.2020.00902.

Polglase GR, Hwang C, Blank DA, Badurdeen S, Crossley KJ, Kluckow M, Gill AW, Camm E, Galinsky R, Brian Y, Hooper SB, Roberts CT. Assessing the influence of abdominal compression on time to return of circulation during resuscitation of asphyxiated newborn lambs: a randomised preclinical study. ARCHIVES OF DISEASE IN CHILDHOOD FETAL AND NEONATAL EDITION 2023 Dec 14:fetalneonatal-2023-326047. doi: 10.1136/archdischild-2023-326047. Epub ahead of print.

Newborn Research

Advancing neuroprotection for pre-term babies

Researchers

Staff and students View

Research groups

Neurology, Neuro-development & Follow-Up View

Research streams

Neonatal Brain Protection View

Meet the team View

Researcher

Associate Professor Flora Wong

Other staff and students

Neuro development and Neuroprotection View

Meet the team View

Researchers

Other staff and students

Research Projects

Perinatal Inflammation and Neurophysiology View

Meet the team View

Researcher

Other staff and students

Interventional Immunology for Early Life Disease View

Researchers

Cell Therapy View

Executive members

Translating Promise into Benefits

Aim

Mission statement

Upcoming event

Cord blood derived therapies

Amnion derived cells

Exosomes/ Extracellular vesicles

iPSC- derived MSCs

Neural stem cells

Selected media highlights

Upcoming events

Past events

Lung & Resuscitation View

Group Head

Researchers

Current projects

Completed projects

Selected publications

Cardiovascular View

Researchers