Research

Most brain growth occurs in the first 1000 days (conception to 2 years), with this period setting the foundation for all future brain development. An insult to the brain during this period can result in neurodevelopmental disorders (intellectual impairment, cerebral palsy, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD)) and life-long consequences including reduced academic attainment, limited employment opportunities, and social issues.

The long-term outcome for children following an early brain insult varies in terms of severity and pattern of impairments.  Our research aims to better understand why some children following an early brain insult develop severe impairments while other develop age appropriately.  We investigate the nature of the brain injury, subsequent brain development, family factors (parental mental health and parenting), and other potential socio-environmental influences.  Findings from these investigations assist in identifying high-risk children who warrant close surveillance and early intervention, and informs avenues for new treatment and management approaches.

Most of our studies involve children born very preterm, but we also research children who experienced birth trauma, fetal growth restriction, diagnosed with a congenital heart disease, and were prenatally exposed to toxic substances.  Our team conducts large prospective longitudinal studies, neuroimaging projects (brain magnetic resonance imaging), and clinical trials of interventions designed to improve outcome.

Areas of research/projects:

Prospective longitudinal outcome studies

1) Victorian Infant Collaborative Study (VICS) Group

Due to advances in medical care, most children born extremely preterm (prior to 28 weeks’ gestational age) now survive.  However, some of the life-saving strategies used may compromise neurodevelopment. Therefore, it is essential to monitor long-term outcome of children born extremely preterm across eras to document changes associated with new management approaches.  We collaborate with the VICS group, which has recruited all children born extremely preterm in Victoria in 1991-92, 1997, 2005, and 2016, along with matched term born controls.  We have ongoing follow-up studies with these cohorts.

2) Asking Questions about Alcohol in Pregnancy (AQUA) Study

Alcohol is teratogenic to the developing fetus, and as such, women who are pregnant or planning a pregnancy are advised to abstain from alcohol.  However, the consequences of low to moderate prenatal alcohol exposure to the fetus is unclear, and consuming some alcohol while pregnancy is common.  The AQUA study recruited a large cohort of pregnant women and measured alcohol consumption, as well as other confounders and mediators. The development of the offspring of these women has been monitored, and we have recently evaluated these children at 6-years with neuropsychological tests, brain imaging and craniofacial analysis.

Neuroimaging studies

1) Victorian Infant Brain Study (VIBeS)

We propose that the variability in the type and severity of impairments observed in children born very preterm is related to the nature of their brain injury and subsequent brain development. In 2001-3 we recruited a large cohort of very preterm children, who had brain scans at term equivalent age.  These children have since been followed-up with developmental tests at 2, 5, 7 and 13 years, with repeated brain scans at 7 and 13 years. This unique cohort has been important for demonstrating the consequences of early brain injury on later brain growth and cognitive/behavioural development.  We are now conducting a 20-year follow-up of this cohort to commence.

2) LaPREM

Children born moderately to late preterm (between 33- 36 week’s gestational age) are rarely studied despite being so common (6% of births) and at-risk for subtle neurodevelopmental problems.  The LaPREM is the first longitudinal study to investigate brain injury and brain development from birth in this population.  The cohort was born in 2010-3, and we are now evaluating them again at age 9 years with brain imaging and neuropsychological / mental health assessments.

Parent studies

It is incredibly distressing for parents who have a critically unwell infant.  We have demonstrated that mothers and fathers of children born very preterm exhibit very high rates of anxiety, depression and post-traumatic stress, especially in the months following the birth.  While these parent responses may be expected, they persist for an extended period and have the potential to influence attachment to their infant, family relations, and parenting behaviours.  We have collected the most detailed longitudinal data on parental mental health – every 2 weeks while in hospital and at 3, 6, 12, 24, 36, and 60 months of child’s age.  We have also conducted a detailed analysis of parenting, by filming interactions between the child and a parent.  Our studies consistently show that specific parenting behaviours are associated with good child outcomes, while other parenting behaviours are related to poor child outcomes.

We are continuing to study the relationships between parental mental health, parenting and child outcomes.  Our findings reflect the importance of focusing on parental well-being and parenting in early intervention programs designed to improve family and child outcomes.

Clinical trials

Our team is involved in clinical trials to determine the effectiveness and safety of obstetric, neonatal, and preventative care interventions.  Following are 2 examples of active trials:

1) TEDI-PREM

It is established that early intervention for at-risk infants results in short-term benefits for the child and family.  However, these interventions are not widely accessible, and are expensive to deliver in person.  Headed by Prof Alicia Spittle at the University of Melbourne, we have developed an intervention delivered in person while the infant is in hospital and then using telehealth post hospital.  This significantly reduces delivery cost and increases access to early intervention. This is particularly relevant in the COVID era.  We are conducting a multi-site trial to assess the interventions effectiveness.

2) Protect-Me trial

Fetal growth restriction is a serious complication of pregnancy in which the fetus fails to reach its full growth potential.  This is usually due to placental dysfunction and results in inadequate oxygen and nutrients needed for fetal development, in particular the brain.  We are involved in a large trial, headed by Dr Kirsten Palmer, to explore whether antenatal melatonin supplementation in severe, early-onset fetal growth restriction improves neurodevelopment at 2-3 years of age.  Melatonin is a potent anti-oxidant that can be used safely in pregnancy.