The Australian Preterm Birth Prevention Alliance

Morris, Jonathan M.; Brown, Kiarna; Newnham, John P.

doi:10.1111/ajo.13171

Cited by 16 publications

(21 citation statements)

References 8 publications

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“…Despite significant efforts, preterm birth in Australia and other resource-rich nations continues to impact around 8–10% of newborns, with even higher rates reported in resource-limited settings. With increased survival into childhood and adult life, the adverse impact of preterm-associated brain injury has become increasingly clear yet there are no targeted postnatal therapies to either mitigate or prevent its occurrence ( Beck et al, 2010 ; Singh et al, 2013 ; Morris et al, 2020 ). Compared to their term-born peers, children born preterm are at an increased risk of developing behavioural disorders such as anxiety and attention deficit hyperactivity disorder (ADHD), in addition to reduced academic attainment at school ( Chyi et al, 2008 ; Lindström et al, 2011 ; Peralta-Carcelen et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Examining Neurosteroid-Analogue Therapy in the Preterm Neonate For Promoting Hippocampal Neurodevelopment

et al. 2022

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Background: Preterm birth can lead to brain injury and currently there are no targeted therapies to promote postnatal brain development and protect these vulnerable neonates. We have previously shown that the neurosteroid-analogue ganaxolone promotes white matter development and improves behavioural outcomes in male juvenile guinea pigs born preterm. Adverse side effects in this previous study necessitated this current follow-up dosing study, where a focus was placed upon physical wellbeing during the treatment administration and markers of neurodevelopment at the completion of the treatment period.Methods: Time-mated guinea pigs delivered preterm (d62) by induction of labour or spontaneously at term (d69). Preterm pups were randomized to receive no treatment (Prem-CON) or ganaxolone at one of three doses [0.5 mg/kg ganaxolone (low dose; LOW-GNX), 1.0 mg/kg ganaxolone (mid dose; MID-GNX), or 2.5 mg/kg ganaxolone (high dose; HIGH-GNX) in vehicle (45% β-cyclodextrin)] daily until term equivalence age. Physical parameters including weight gain, ponderal index, supplemental feeding, and wellbeing (a score based on respiration, activity, and posture) were recorded throughout the preterm period. At term equivalence, brain tissue was collected, and analysis of hippocampal neurodevelopment was undertaken by immunohistochemistry and RT-PCR.Results: Low and mid dose ganaxolone had some impacts on early weight gain, supplemental feeding, and wellbeing, whereas high dose ganaxolone significantly affected all physical parameters for multiple days during the postnatal period when compared to the preterm control neonates. Deficits in the preterm hippocampus were identified using neurodevelopmental markers including mRNA expression of oligodendrocyte lineage cells (CSPG4, MBP), neuronal growth (INA, VEGFA), and the GABAergic/glutamatergic system (SLC32A1, SLC1A2, GRIN1, GRIN2C, DLG4). These deficits were not affected by ganaxolone at the doses used at the equivalent of normal term.Conclusion: This is the first study to investigate the effects of a range of doses of ganaxolone to improve preterm brain development. We found that of the three doses, only the highest dose of ganaxolone (2.5 mg/kg) impaired key indicators of physical health and wellbeing over extended periods of time. Whilst it may be too early to see improvements in markers of neurodevelopment, further long-term study utilising the lower doses are warranted to assess functional outcomes at ages when preterm birth associated behavioural disorders are observed.

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Section: Introductionmentioning

confidence: 99%

Examining Neurosteroid-Analogue Therapy in the Preterm Neonate For Promoting Hippocampal Neurodevelopment

et al. 2022

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“…The study by Cushing defined spontaneous PTB as PTB without labour induction and found a rate of 10.3% which may be an overestimate given the national PTB rate of 10.9% 1 and that only a subset of PTB is spontaneous. In contrast, the study in NSW defined spontaneous PTB as PTB with spontaneous onset of labour and reported a rate of 3.2% which is likely an underestimate given the national PTB rate of 8.7% 2 and that the majority of PTB is spontaneous 7 . In the former, patients who presented with severe pre‐eclampsia and had a pre‐labour caesarean birth without any labour induction due to concern for foetal well‐being would have been potentially misclassified as spontaneous PTB which could explain the high rate of ‘spontaneous PTB’.…”

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confidence: 93%

“…In the most recent 2020 U.S. data, non‐Hispanic Black infants (13.4%) were born preterm 50% more often than non‐Hispanic White infants (9.1%) 1 . Similar disparities exist in Australia with Indigenous infants (14%) born preterm from which is higher than the national rate of 8.7% in 2017 2 . Explanations for these longstanding differences are not well understood, however, but rigorous work has shown that disparities in birth outcomes are due to environmental as opposed to genetic differences 3 …”

mentioning

confidence: 98%

“…1 Similar disparities exist in Australia with Indigenous infants (14%) born preterm from which is higher than the national rate of 8.7% in 2017. 2 Explanations for these longstanding differences are not well understood, however, but rigorous work has shown that disparities in birth outcomes are due to environmental as opposed to genetic differences. 3 Many environmental exposures are inequitably distributed across race/ ethnicity and socioeconomic status, including access to high-quality health care, exposures to ambient air pollution and other toxicants, physical buffers such as green space, and exposure to social stressors including violence.…”

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confidence: 99%

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Rising global temperatures is likely to exacerbate persistent disparities in preterm birth

Clougherty

Burris

2021

Paediatric Perinatal Epid

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“…Preterm birth complicates 8.7% of pregnancies in Australia. 1 As a major cause of perinatal mortality and morbidity, it generates ongoing research aimed to reduce its prevalence. [2][3][4] A short cervical length (CL) on ultrasound in mid-pregnancy is a recognised indicator of an increased risk of preterm birth.…”

Section: Introductionmentioning

confidence: 99%

Consistency in the transabdominal ultrasound measurement of cervical length in mid‐pregnancy

Pedretti

Nathan

Doherty

et al. 2022

Australas J Ultrason Med

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Purpose The Western Australian Preterm Birth Prevention Initiative recommends a transabdominal cervical length (TACL) measurement at the mid‐pregnancy ultrasound to screen low‐risk women for preterm birth risk. In view of this recommendation, we assessed the inter‐observer consistency of TACL screening in mid‐pregnancy. Methods Routinely collected mid‐pregnancy TACL ultrasound images were graded from 0 to 4 according to the anatomical landmarks identified by a single expert. A random selection of 10 images of each grade were disseminated in an electronic survey to determine inter‐ and intra‐observer variations in the classification of the cervical image. Results A total of 244 participants graded 50 TACL images. Six participants repeated the grading. Overall agreement to the exact initial grade for all images was 49.6%, highest for images at both ends of the spectrum (83% Grade 0 and 70.4% for Grade 4). Overall agreement to the initial diagnostic Grades 3 and 4 was 75.3% (95% CI 74.5–76.0%) and was higher when the maternal bladder was empty. There was moderate inter‐rater agreement (κ = 0.42) for Grades 3 and 4 (diagnostic) or Grades 1 and 2 (non‐diagnostic). The intra‐rater agreement was fair to good (κ = 0.59, 95% CI 0.49–0.70) for those who repeated the assessment (including the expert grader). Conclusions Sonographic CL screening is considered an important tool for the identification of women at high risk of preterm birth. Image classification of TACL performed poorly compared with previous studies assessing transvaginal cervical length. Improved reliability and measurement consistency may be achieved through high levels of quality assurance, ongoing training and image audit.

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The Australian Preterm Birth Prevention Alliance

Cited by 16 publications

References 8 publications

Examining Neurosteroid-Analogue Therapy in the Preterm Neonate For Promoting Hippocampal Neurodevelopment

Examining Neurosteroid-Analogue Therapy in the Preterm Neonate For Promoting Hippocampal Neurodevelopment

Rising global temperatures is likely to exacerbate persistent disparities in preterm birth

Consistency in the transabdominal ultrasound measurement of cervical length in mid‐pregnancy

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