RPA NEWBORN CARE

DEPARTMENT OF NEONATAL MEDICINERoyal Prince Alfred Hospital

Sydney Australia

2006-2007 Review

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Foreword 1

Staff Directory 3

Newborn Care Babies Jessica Anne Curley 4 Ruairi Ryan 6 Hugo Ceran-Jerusalemy 8

Newborn Care Clinical Audit 10

Publications 11

Research Projects 12

Presentations 14

Educational Achievements 16

DHS: a tribute 17

International Education 18

Family Support Team 20

Developmental Follow Up 21

Farewell to Amanda Durack 22

Welcome to Dahlia 23

International Visitors 23

Friends of RPA Newborn Care 24

Honour Roll of Donors 25

Welcome to the 2006 - 2007 bi-annual report for RPA Newborn Care. These have been years of

consolidation, transition and a little expansion, and this is reflected in the contents of this report.

We have consolidated our role as one of the major providers of tertiary level intensive care for newborns in NSW. The statistics, drawn up by Dr Phil Beeby on page 10, show how we look after more than 700 babies each year, why they needed our help and their generally excellent outcomes.

Individuals get lost in statistics and we’re very grateful to the parents of Jessica Curley, Ruari Ryan and Hugo Ceran-Jerusalemy for sharing their stories. Each story shows the emotional highs and lows that all parents will go through with a sick newborn baby. Their stories also show the range of care that we provide both for preterm and term babies and both for local families and families from throughout NSW whose local hospital does not have newborn intensive care facilities.

We have maintained our role at the forefront of research into continuing improvement of outcomes for newborn babies and in education as a means of supporting the most precious resource we have in health care, our staff.

The transition detailed in this report comes from the moving on of three really key figures in the development of RPA Newborn Care. Professor David Henderson-Smart AO retired at the end of 2007 (see page 17). David had been part of RPA Newborn Care since 1979 and almost all of the great things we have in the department are a legacy of his time as Head.

His legacy extends well beyond RPA and he had an immense state-wide, national and international impact on perinatal care. He was a great mentor and role model for many of the upcoming generation of neonatologists, including myself, and his input is sorely missed. I am however assured that there will be some great vintages coming soon from his vineyard in Tasmania.

Amanda Durack moved on after 10 years as our fundraising coordinator (see page 22). Amanda single-handedly transformed our fundraising effort and much of the current equipment in Newborn Care was purchased as a result of her efforts and the generosity of all our donors.

Kirsty Foster moved on after seven years as medical educator and she also transformed our educational activities for all our staff (see page 16). Both Amanda and Kirsty have moved to full time positions in the University of Sydney and we will be maintaining and building on the legacy of their achievements.

The expansion comes from a booming birth rate, over 5,000 deliveries a year in the hospital. Newborn Care was designed for 8 intensive care beds and after funding for extra intensive care beds was allocated, we increased from 8 to 10 ICU beds in 2007. This will bring new opportunities and challenges that we will tell you about in our next bi-annual report. Thank you for your interest in our department.

Foreword

Cover photograph: Emma Ekins with her son Eamonn (aka Eddy), who was born at 25 weeks and is pictured here at approximately three months old. Photography by Ray Riley for SSWAHS-RPAH Audiovisual Services.

Editing: Shelley Reid, RPA Newborn Care

Design: Katrina Nicolson, Lemon & Lime Design

Printing: Online On-Demand Printing

Contributors Phil Beeby Dahlia Brigham Nick Evans Heather Jeffery Kelly Leven Girvan Malcolm Ingrid Rieger and parents of Newborn Care Babies

Acknowledgment RPA Newborn Care wishes to thank Lemon & Lime Design and Online On-Demand Printing for their generous support in producing this review.

Associate Professor and Head

Department of Neonatal Medicine

Royal Prince Alfred Hospital

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Heather JefferyPhD MPH FRACP MRCP(UK)Clinical Associate Professor & NeonatologistHead of Department, Neonatal Medicine (until March 2008)

David Henderson-Smart AOPhD FRACPProfessor of Perinatal Medicine & NeonatologistDirector, Perinatal Services NetworkDirector, Centre for Perinatal Health Services Research

Nick EvansMRCP(UK) DMClinical Associate Professor & NeonatologistHead of Department, Neonatal Medicine (2008)

Ingrid RiegerFRACP Clinical Lecturer & Developmental Paediatrician

Philip BeebyPhD FRACPClinical Senior Lecturer & Neonatologist

David OsbornMB BS MM(Clin Epi) FRACPDirector, NICUClinical Associate Professor & Neonatologist

Crista WocadloPhD Clinical PsychologistDevelopmental Follow Up

Sandie Bredemeyer OAMRN RM MAppSc(Nursing) PhDClinical Associate Professor & Clinical Nurse Consultant, Perinatal Nursing

Simon BurkeRN BN GradDipBusNurse Unit Manager, Newborn Care

Dr Sue AdamsProfessor Frank BillsonDr Jonathon Craig

Dr Maurie GettProfessor David IsaacsDr Con James

Dr Erik La HeiDr Hugh MartinDr Gary Sholler

Visiting Medical Officers

Kirsty FosterBSc(MedSc) MBChB MRCGP DRCOG MEdPostgraduate Educator

Lyndy DixonRN RM NICC IBLC Cert. Child &Family Health BHealthManagementNurse Unit Manager (Evening)

Adrienne GordonMBChB MRCP(UK) FRACP MPH(Hons)Staff Specialist Neonatologist

Clinical Nurse Consultant Assoc. Professor Sandie Bredemeyer OAM

Nurse Unit Managers Simon Burke Lyndy Dixon (Evening)

Clinical Nurse Educators Vicky Wade/Louise Corcoran Nicole Ensbey/Alison Small

Theatre Midwives Kim Suttor Nanette Stacey

Lactation Support Georgina Jandera Trish Mumford

Clinical Nurse Specialists Lisa Cutrupi Maria Daco Yvonne Foo Penny Janes Noel McNamara Susanne Oliver Jan Polverino Nicki Riddell Laurel Simmons Helen Slater Jan Smith Julee Stephens

Registered Nurses Abigail Barham Janet Barlow Alison Blackmore Lisa Bogan Bonita Bosman Sara Brown Joanne Burgess Sam Carton Young Mi Choi Sabrina Choo Sarah Chen Stephen Clayton Kim Collins Anne Cunneen Lynda Darya Rosemaree Dekker Caroline Drown Diana Dundas Emily Dunn Donna Durante Edwina Easterman Karen Emery Kate Evans Grace Fernandez Bonnie Fonti Catherine Ford Lydia Fung Colleen Garrard Ester Gibbons

Letetia Gibbs Anthea Goh Sarah Grellman Tracey Halliday Sandra Hamdorf Karen Harding Vanessa Harvey Brenda Jans van Vurren Marion Ingram Rachael Irwin Barbara Johnson Anne-Marie Jones Renee Keogh Sarah Kenny Christine King Dina Kliendiest Jin Lee Siew Lee Natalia Le Tortorec Kelly Leven Serena Liew Nicole Low Rachael McTiernan Kara Mobb Cheryl Paisley Stephanie Peat Lisa Peereboom Enid Pereira Natalie Peyton Bridget Pittorino Katherine Powers Tracy Puckridge Jennifer Rhodes Glenda Rivers Jennifer Robinson Elizabeth Roden Mirja Roti Kate St Claire Nadia Sigrist Diane Singleton Kasia Skorza Anna Smith Maria Spinola Boonta Sriviseass Kelly Stone Claire Sutcliffe Miew Choo Teoh Magdalene Thomas Michelle Thompson Karina Timoteo Sirpa Tobin Kai Eng Toh Rhiannon Tozer Katherine Verrils Usha Vishran Jean Walker Jane Williams Nicole Woodcock Sunilla Xavier Nicole Yap Jessica Yeo Khee Lwant Yeo

Enrolled Nurses Yvonne Evers Myrian Sabariz Marija Svagaroska Leisa Swinton

Clerical/secretarial staff Belinda Askew Anna Cincotta Yvonne Hanney Ambrose Schonberger Raquel Villareal

Ward Assistants Roska Buteska Zohra Cvetkovska Liboria Perischella Alissa Toumassian

Family Support Nurses Allison Bogaert Valerie Drayton Claire Morgan Lenore Wright

Follow Up Coordinator Claudia Schwatlo

Follow Up Team Crista Wocadlo Clinical Psychologist Danielle Hinwood Physiotherapist

Clinical Audit Officer Shelley Reid

Staff Specialists Assoc. Professor Heather Jeffery Professor David Henderson-Smart AO Assoc. Professor Nick Evans Dr Ingrid Rieger Dr Philip Beeby Assoc. Professor David Osborn Dr Adrienne Gordon

Postgraduate education Dr Kirsty Foster (- 2006)

Career Medical Officer Dr Girvan Malcolm

Neonatal Fellows Kathryn Carmo Bronwyn Dixon Helen Miller

Registrars Nagaruban Arumugan Chloe Baxter Paul Benitez Andrew Biggin Joceline Branson

Foo Feng Christopher Haertel Timothy Hong Alison Howell Helen Kasby Lynette Khoury Katharine McDevitt Catherine McGettigan Angela McGillivray Samridh Nagar Deborah Perkins Janini Ponnampalam Mohammad Arif Qureshi Bjarte Rogdo Bithi Roy Sacha Ruberu Sridhar Santhanam Kyrie Shoemaker Alys Swindlehurst John Tan Jutta Zimmerman

Residents Wendy Bailey Shweta Batra Philip Britton Helen Buchtmann Suzy Byrnes Lisa Chau Lisa Cheng Ellen Conway Lucia Porta Cubas Michael Culshaw Rebecca Don Hong Du Annabelle Enriquez Jacqueline Fleming Azhar Khan Christine Lau Raelia Lew Tamadur Mahasneh Vishal Malhotra Anthony Marren Sylvia Martin Shivani Moodley Virginia Noronha Ernest Paw Mohammad Rahman Thilini Ranasinghe Tyler Schofield Paul Tembo Alison Williams Shannon Zawada Anthony Zehetnar

Technical Support Officer Gerrit Werkhoven

Fundraising Coordinator Amanda Durack/Dahlia Brigham

Staff List Staff Directory

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When our first child Amelie was 8 months old we found out there was another baby on the way.

My first pregnancy was a breeze and the labour was quick, it would be a piece a cake second time, right? ... wrong.

At 25 weeks and 4 days gestation I had cramps all morning but didn’t think anything of them until one of the cramps stopped me walking while out shopping. I finally contacted the midwives at the hospital where we had planned to deliver.

As a precaution I was given antibiotics and a steroid injection. The contractions (no point in denial now) slowed and I thought I’d be back at work the next day. My obstetrician examined me and found I was 3cm dilated and the baby was in a breech position. I’ll never forget his words, “Jenny this is now very serious, you are in labour and we need to get you transferred to a hospital with a neonatal intensive care unit”. Thanks to his swift action I was sent to RPA. My husband Ben packed some things for Amelie and my wonderful parents stepped in to look after her. We never thought at that time they would be there for 4 months.

The midwives were wonderful. Despite suppression of my labour, ultrasounds revealed that the baby was going to deliver imminently. We felt helpless, wished it all to go away and tried desperately to cognate that this was all in fact very real. We cried a lot and although the drugs had taken the physical pain of labour away the emotional pain remained. One of the neonatologists had the unenviable task of giving us survival statistics and should our baby survive what her chances of normal outcomes were. That is, 70% probability of survival, and 25% of those kids with no adverse outcomes.

So at 25 weeks and 5 days at 5pm on 29 November 2006, Jessica Anne Curley was born by caesarean section, weighing 794 grams. She was immediately intubated and in the care of the amazing Newborn Care team. In my anaesthetic haze Ben showed me a photograph of Jess. Relief flooded me and at some deep level I felt like everything was going to be okay. It was and still is, but boy that initial certainty faded and wavered along the way.

I remember waking up the next morning and thinking to myself that I’d had a baby, but there was no baby next to me. Soon after, I was instructed to start expressing breast milk, which was one area I had control over and though a chore at times I ended up treating it like relaxation time.

I was petrified to see Jess but found a tiny, fragile, little thing so very dependant on her nurses, doctors, equipment and drugs. Jan was the first nurse I met and she started talking straight away, explaining the equipment, drugs and all the risks an extremely preterm baby faces; it was reality and Jan knew we needed to come to terms with our new situation. She instantly had my trust and over our 90 odd days at RPA she would seemingly and instinctively seek me out to give me a reality check when I needed it (or didn’t need it as I sometimes felt). There was always some advice about what tests would be coming up or questions like, “Have you had a day off yet, you need it”. Jan cared for Jess (and us) on Christmas day and then on Jess’s 100th day, and after we had been transferred to a local hospital, I arrived home to find a card from Jan wishing us well.

The Newborn Care staff do so much more than care for ill babies. Jan was just one of an amazing team who we remember with immense gratitude and fondness. To think that we have fond memories of Jess’s time in the nursery given what we were all going through, shows that despite being in such a clinical environment we were made to feel at home and that there was no doubt in our minds that Jess was receiving the best care available. We know that there is so much more than just luck involved in how well our Jess has done.

The first week was a blur and such an emotional time. I do recall on about day 3 the nurses calling Jess ‘Little Miss Feisty’; I felt so proud of her! She was giving some real attitude apparently, and even though we thought they were just trying to make us feel good, Jess lives up to that name today.

Jess was ventilated for 3 days, spent about 7 weeks on CPAP, and had no major medical setbacks. Her main hurdle was intolerance to feeds. It was 5 or 6 weeks before she accepted milk. We would watch the scales on weigh days, hoping for weight gains as she was still so tiny.

I had my first cuddle of Jess two weeks after she was born. Again I was petrified and incredibly emotional, but that cuddle marked the start of me feeling like I could do something to help Jess. The staff and the literature all emphasized the importance of skin to skin cuddles to maximise Jess’s development. At first it was once every few days if she was well enough, gradually becoming daily.

As Jess progressed through to the high dependency and special care nurseries we were able to start breast feeding, once a day at first then up to twice a day. That required two trips to RPA each day from home, trying also to be a mum to Amelie. Many people have asked how we managed. It has always come down to the help our family gave us, which we are so lucky and grateful for.

After 90 days at RPA Jess was transferred to St George Hospital and after 110 days she joined us at home. Home life wasn’t without its challenges, however. Jess had awful reflux and slow weight gain, and I had postnatal depression. But we battled on and miraculously got through our first winter at home without even a sniffle. Gradually our fear of Jess getting sick evaporated and we crept back into life again.

Jess Mess (her nickname by all her family) has just celebrated her second birthday, messily eating as much cake as her mum and dad would let her, and protesting rather strongly when it was all gone! So far she has met all of her corrected age milestones and is one exceedingly vibrant, loveable, tough, determined and very giggly little girl. She is loved by her big sister and all her cousins and of course her parents and grandparents think she is amazing. We feel so incredibly lucky to have her in our lives and will never forget where her big little life began.

Jennifer Curley.

Jessica Anne Curley

Jessica at RPA Jessica at 2 years

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Ruairi was born on 2 April 2007 at just 25 weeks. As first time parents, we knew nothing ...

One Friday night, I started to have some light bleeding. Saturday morning I went to RPA and everything seemed normal but I was kept in for observation and for a scan on Monday morning. Throughout Saturday and Sunday, I was experiencing some pain which was attributed to the fibroids. By Monday morning, I was really uncomfortable and on scanning it was discovered that I was 7cm dilated and this baby was coming out!

Before I knew it we were in the delivery ward with people running around. I received drugs to help our baby’s lungs develop, doctors were explaining our baby’s survival chance and even then there may be complications, nurses from Newborn Care explained how our baby would be managed after the birth - there was a lot to take in. One hour and 40 minutes later, Ruairi arrived, weighing just over 1 kilogram.

Before I explain what happened over the next 104 days that Ruairi was in hospital, I’d like to express my thanks to the nurses and doctors of Newborn Care - everyone was fantastic and their professionalism and dedication has to be commended as I don’t think that Tom and I would have got through it without their help and never-ending support.

For the first few days we could barely see our boy with all the tubes and equipment around him. Ruairi was on a ventilator to help him breathe for 3 days then he was put on CPAP, as he was breathing on his own but just needed help keeping his airways open. He was put under lights to treat jaundice. I remember that even though Ruairi had the smallest nappy possible on

him, it took up most of his body. As I’m writing this, I’m going through the journals I kept during our time in the hospital. One of the best things the nurses gave us in the very beginning was a blank book to write in. I took this and ran with it, so much so that I have three books. Even though we knew Ruairi was in a serious condition, every time we visited the nurses would try to tell us a funny story. Within a week, I had written in the journal how Ruairi had managed to pee through the window at one of our lovely nurses. This was important because even though we couldn’t cuddle Ruairi yet, we felt that he was developing a personality.

We were told that Ruairi had an open ductus arteriosus. This usually closes within the first few days after birth but if it remained open could lead to heart failure or fluid on the lungs. It can be treated firstly with drugs but if not successful, then by an operation. The drugs closed Ruairi’s ductus and we breathed a sigh of relief, however over the course of the first 4 weeks, Ruairiís ductus kept opening and closing. This was a very stressful time as we didn’t fully understand what it meant, only that it could mean an operation.

Exactly one week after Ruairi was born we received our first official communication from him in the form of an Easter card, which included a print of his gorgeous feet (another wonderful nurse initiative). A small thing in comparison to all the amazing medical help Ruairi was receiving but it gave us something positive to talk about.

Ruairi experienced all the usual issues with feeding and regularly had his feeds downsized then gradually increased again. Ruairi also had some blood infections

requiring antibiotics and also had blood transfusions to increase his red blood cells. At one point, he was having so many different antibiotics that he had intravenous lines in both feet and one arm, which only left one hand for us to touch.

Ruairi had apnoea spells due to his prematurity. On the worst day he had 16 recorded. If the nurses said Ruairi was ‘cheeky’ during the day this meant they only had to gently prompt Ruairi and he would start breathing again. However, if he was ‘naughty’ that meant that the oxygen had to come out. It took some time to get used to Ruairi regularly setting off the alarms and not panicking when this happened. It took 3 weeks to discover that Ruairi had blond hair as this was the first time the CPAP came off, for weighing. It also took this long for Ruairi to regain his birth weight.

We were about 3 weeks into our stay when a nurse from the family support team talked to us about Ruairi going home once he could breathe on his own, feed on his own and sleep in an ordinary cot. This was the first time that we realised that Ruairi would be coming home with us and it was articulated in such a way that we knew what our key milestones were. We still had some way to go but it changed our focus and we started planning for the future.

Three and a half weeks later, we got our first cuddle with Ruairi which was amazing! Even though we had to hold Ruairi with his CPAP tubing on and right in the middle of a big cushion, it was still amazing as we could hear Ruairi breathe through the CPAP and even hiccup (noises you can’t really hear when in the incubator).

Ruairi celebrated his 8-week-old birthday by coming off CPAP altogether and moving from intensive care into the high dependency unit. This was a fantastic feeling as we knew that Ruairi had reached his first milestone. Nine weeks later, Ruairi was sleeping in a cot; by week 10 we had moved to the special care nursery. Ruairi spent the last 5 weeks there, putting on weight and learning to feed.

A week before Ruairi was due to come home he was transferred to The Children’s Hospital at Westmead to have a double hernia operation. This was a routine operation but wasn’t successful and Ruairi celebrated 100 days in hospital by having a repeat operation. It was very stressful for us as we had got used to Ruairi being lively and to see him unwell and sedated from his first operation brought back the early days for us which we thought were behind us.

A few days later and we were home. The funny part of it all was when we finally got him home we just sat around looking at him and thinking, “What do we do now? Entertain us, Ruairi!” Well, he certainly did later on when he decided to keep us up for most of the night. Welcome to parenthood!

Ruairi is now 18 months old and thriving. He is walking, loves calling people on our mobile phones and generally getting his own way!

Kerry, Tom and Ruairi Ryan

Ruairi Ryan

Ruairi at RPA Ruairi at 2 years

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Like many of the children who appear in this publication, Hugo had an unusual and complicated

start to life. My husband (Patrick) and I had been living in Tahiti, French Polynesia but had decided to come back to Sydney for Hugo’s birth. We were glad we did.

I had a fairly uneventful pregnancy and went into labour with Hugo within two days of his due date. I arrived at the Prince of Wales Private Hospital in Randwick at around 3:15am. At around 10 minutes to 6 Patrick pressed the buzzer, assisted me to the bed and the midwife checked on my progress. It was all a fast and dramatic blur after that. I remember hearing the midwife say very calmly and clearly, “Your baby is having difficulties, we need to get him out fast, listen to what I say and push exactly when I tell you and he will be fine”. At 6:19am Hugo was born and suddenly the room was full of people. We heard a couple of ‘zero’ Apgar scores and we knew this wasn’t good. After about 10 minutes most people left and soon after the neonatal paediatrician explained that Hugo had been born not breathing and it had taken over 10 minutes to revive him. He was now showing signs of a condition known as hypoxic encephalopathy, resulting from a lack of oxygen to the brain. Then the paediatrician explained that there was a clinical trial being conducted for babies born with this condition. It was called the ‘ICE trial’ and the babies were divided into a control group (who received routine supportive care) and a ‘treatment’ group who were cooled to reduce their body temperature. The idea was simple: if you could cool the body down, this may reduce the harm to the brain from lack of oxygen. If we agreed to allow Hugo onto the trial it had to start

within 6 hours of his birth. The trial was based on a randomised system so we could not choose whether he would be in the control group or cooled. We were then given two pages of information to read and left to think.

It was all too much. We had not even seen Hugo.

The doctor came back and apologised for not giving us much time, but explained that we didn’t have much time to decide. So we agreed and made our first decision as parents.

We were then told that the Royal Hospital for Women did not have enough staff or beds to look after Hugo and so he was to be transferred to RPA. Within half an hour the Newborn Emergency Transfer Service (NETS) team had arrived and were ready to put Hugo into the ambulance. I had only just made my way out of bed and Patrick and I saw Hugo for the first time. Before they left, the NETS doctor took a photo of Hugo, and we were left alone with that. Somewhere in this blur my parents arrived and drove Patrick and me to RPA.

By the time we found him in RPA Newborn Care, Hugo was about 5 or 6 hours old. When we arrived Dr Gordon was sitting beside Hugo and explained to us the ICE trial procedure. We were struck by how huge Hugo looked (at around 4kg) compared to the tiny babies surrounding him. Most of them were in humidicribs but Hugo was lying with ice packs around him, the simple technique used to cool him. He was cooled him for 72 hours and then returned slowly to normal temperature. No-one was sure how acutely he had suffered at birth was or how effective the cooling would be.

The following days were very emotional for us. We spent most of our time in the nursery and were very grateful to be involved in feeding Hugo and changing his nappy. The postnatal ward midwives were terrific and I do not know how we would have got through this period without them. They were incredibly sensitive to us and allowed us to stay together, apart from the rest of the ward, to give us space.

Within three days Hugo had a seizure and was put on phenobarbitone. He had an MRI and also other scans following the seizure. The MRI revealed a clot on his brain and this added to the unknowns about his condition. The doctors updated us daily; however there appeared to be more questions than answers.

As this was our first child we barely grasped what it meant to be parents, let alone how this role may be affected by a child with possible brain damage. The staff were a fantastic support to us during this time. One of the most moving moments of our stay occurred on the morning of Fathers’ Day when Patrick emerged (red-eyed) from the nursery with a Fathers’ Day card. We both cried when we saw the tiny blue foot on the cover, and then laughed later to see all the babies who had been hard at work the previous night now lying in their cribs with coloured feet.

Around day 6 of our hospital stay, Hugo’s condition seemed to improve. The phenobarbitone wore off and Hugo started breast feeding almost immediately. This

was seen as a very good sign. Second opinions were sought on the brain clot and it appeared this was most likely the cause of the fit. Within a few days Hugo was receiving care as would a normal baby. Dr Osborn finally told us that Hugo was ready to go home. We took him to our room, learnt to bath him and left the next day.

Hugo is now three years old and has come a long way from the sad little baby his first photos would suggest. RPA Newborn Care followed him for 2 years after his discharge to observe his development following the ICE trial. When Hugo was about a year old we were told that the prognosis of babies cooled on the ICE trial had so improved that the trial stopped and cooling was now a mainstream treatment.

Patrick and I both feel very fortunate that Hugo emerged from all of this to become a normal, healthy little boy. We look back on the time of his birth with a lot of mixed emotions, but are very grateful for the wonderful care Hugo received while at RPA and for the support that was offered to us throughout our stay. I am also pleased my mother (Dahlia Brigham) has joined RPA Newborn Care as their fundraiser. This somehow feels like the right outcome for our family for the support they offered us when we needed it most.

Callantha Brigham and Patrick Ceran-Jerusalemy(aka Hugo’s mum and dad)

Hugo Ceran-Jerusalemy

Hugo at RPA Hugo, Christmas 2008

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Table 1 shows the number of babies born at RPA and admitted to RPA Newborn Care and the number of infants born at other hospitals and transferred to RPA Newborn Care after birth. In 2006-2007 there were a total of 10,384 births at RPA (5,043 in 2006, 5,202 in 2007), compared with 4,463 in 2005, 4,112 in 2004, 4,146 in 2003 and 3,623 in 2002. The steady increase since 2002 reflects the greater demand following the move to brand new facilities.

Figures 1 and 2 show the 2006-2007 admissions to RPA Newborn Care. Figure 1 shows admissions by gestational age and Figure 2 shows admissions by birth weight. Whenever possible we avoid separating mother and newborn, and by national benchmarks, an admission rate of 14% is a very good result for a tertiary unit.

Reason for admission to RPA Newborn Care

Figure 3 outlines the main reasons for admission in 2006 and 2007. The largest group was admitted simply because they were too premature or too small to go directly to the postnatal ward with their mother (34 or less weeks). Babies older than 34 weeks only get admitted to RPA Newborn Care when there is a specific reason for admission. The most common of these was respiratory distress. The large majority of these are babies with respiratory distress syndrome, transient tachypnoea, and meconium aspiration.

The next most common specific reason was jaundice requiring phototherapy. This has increased despite the use of Bilibeds on post-natal wards, and probably reflects the increasing proportion of babies born to mothers of ethnic backgrounds that have an increased incidence of jaundice. Next came babies born with mild prematurity (34-37 weeks) who did not feed adequately or maintain their body temperature.

The category ‘Other’ includes a variety of uncommon reasons, such as congenital abnormality. The boarders are infants whose mothers are temporarily too unwell following delivery to care for their newborns.

Survival rates for RPA Newborn Care

Figure 4 shows the survival rate of babies born in 2006 and 2007 for all infants admitted to RPA Newborn Care, by their gestational age groups. The data are presented for survival to discharge from RPA, and infants with a lethal congenital abnormality are excluded.

Length of stay in NICU

Figure 5 shows the average age in days at time of discharge for all infants discharged to home from RPA Newborn Care. Thus a baby born at about 25 weeks would usually go home very close to the ‘expected date of confinement’. For a given gestation at birth, the expected length of stay at RPA is most influenced by whether or not the baby goes directly home, or is transferred back to a hospital closer to their home. Medical complications may cause the stay to be lengthened, irrespective of the final destination.

Clinical Audit 2006- 2007 Publications 2006-2007Book chaptersEvans N (2007). Patent Ductus Arteriosus. In: Polin RA &Yoder MC (Eds). Workbook in Practical Neonatology. Philadelphia: WB Saunders.Jeffery HE, Lahra MM (2007). Perinatal Infections. In: Keeling JW & Khong TY (Eds). Fetal and Neonatal Pathology (4th Ed). USA: Springer Verlag.Jeffery HE, Hill DA, Morris J, Elliott E, Adams C. (2007). Evaluation of the National Train-the-Trainer SCORPIO Workshop. Report for UNFPA Vietnam.

Journals Allen CW, Jeffery HE (2006). Implementation and evaluation of a neonatal educational program in rural Nepal. J Trop Pediatr doi:10.1093/tropej/fmi106.Bredemeyer SL, Polverino J (2006). Assessment of jaundice in the term infant: a clinical challenge: Part 1. Neonatal, Paediatric and Child Health Nursing 9:3, 15-20.Bredemeyer SL, Polverino J, Beeby PJ (2007). Assessment of jaundice in the term infant: accuracy of transcutaneous bilirubinometers compared with serum bilirubin levels. Neonatal, Paediatric and Child Health Nursing 10:1, 5-12.Browning Carmo KA, Evans N, Isaacs D (2007). Congenital candidiasis presenting as septic shock without rash. Archives of Disease in Childhood 92:7, 627-628.Evans N (2006). Which inotrope in which baby? Archives of Disease in Childhood 91, 213-20.Evans N (2006). Assessment and support of the preterm circulation. Early Human Development 82, 803-810.Evans N (2007). Prognostic tests in babies: do they always help? Acta Paediatrica 96:3, 329-330. Evans N, Hutchinson J, Simpson J, Donoghue D, Darlow B, Henderson-Smart D (2007). Prenatal predictors of mortality in very preterm infants cared for in the Australian and New Zealand Neonatal Network (ANZNN). Arch. Dis. Child. Fetal Neonatal Ed 92, F34-F40.Gordon A, Isaacs D (2006). Late Onset Neonatal Gram negative bacillary infection in Australia and New Zealand: 1992-2002. Pediatric Infectious Disease Journal 25, 25-29.Isaacs D, Kilham H, Gordon A, Jeffery HE, Tarnow-Mordi W, Woolnough J, Hamblib J, Tobin B (2006). Withdrawal of neonatal mechanical ventilation against parents’ wishes. J Paed Child Health 42, 311-315.Jeffery HE, Norden M, Mackenzie A, et al. (2006). Guidelines for management of procedure-related pain in neonates. J Paed Child Health 42, S31-39.Kluckow M, Seri I, Evans N (2007). Functional echocardiography: an emerging clinical tool for the neonatologist. Journal of Pediatrics 150, 125-130.Lahra MM, Gordon A, Jeffery HE (2007). Chorioamnionitis and fetal response in stillbirth. AJOG 196:229, e1-4.McDonald H, Brocklehurst P, Gordon A (2007). Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews 1:CD005945. Osborn DA, Evans N, Kluckow M (2007). Left ventricular contractility in extremely premature infants in the first day and response to inotropes. Pediatric Research 61:3, 335-340.

Osborn DA, Evans N, Kluckow M, Bowen JR, Rieger I (2007). Low superior vena cava flow and effect of inotropes on neurodevelopment to 3 years in preterm infants. Pediatrics 120:2, 372-380. Osborn DA, Hunt RW (2007). Postnatal thyroid hormones for preterm infants with transient hypothyroxinaemia. Cochrane Database of Systematic Reviews 1:CD005945.Osborn DA, Hunt RW (2007). Postnatal thyroid hormones for respiratory distress in preterm infants. Cochrane Database of Systematic Reviews 1:CD005946.Osborn DA, Hunt RW (2007). Prophylactic postnatal thyroid hormones for prevention of morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 1:CD005948. Osborn DA, Paradisis M, Evans N (2007). The effect of inotropes on morbidity and mortality in preterm infants with low systemic or organ blood flow. Cochrane Database of Systematic Reviews 1:CD005090.Osborn DA, Sinn J (2006). Soy formula for prevention of allergy and food intolerance in infants. (Update). Cochrane Database of Systematic Reviews 4:CD003741. Osborn DA, Sinn J (2006). Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. (Update) Cochrane Database of Systematic Reviews 4:CD003664. Osborn DA, Sinn JK (2007). Probiotics in infants for prevention of allergy and food hypersensitivity. Cochrane Database of Systematic Reviews 4:CD006475.Osborn DA, Sinn JK (2007). Prebiotics in infants for prevention of allergy and food hypersensitivity. Cochrane Database of Systematic Reviews 4:CD006474. Osborn DA, Sinn JK (2007). The Cochrane Library and dietary prevention of allergy and food hypersensitivity in children: an umbrella review. BMJ Evid Based Child Health 2, 541-552.Paradisis M, Evans N, Kluckow M, Osborn D, McLachlan AJ (2006). Pilot study of milrinone for low systemic blood flow in very preterm infants. Journal of Pediatrics 148, 306-313. Paradisis M, Jiang X, McLachlan A, Osborn DA, Kluckow M, Evans N (2007). Population pharmacokinetics and dosage regimen of Milrinone in preterm infants. Archives of Disease in Childhood 92:3, F204-209. de Waal KA, Evans N, Osborn DA, Kluckow M (2007). Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns. Arch Dis Child Fetal Neonatal Ed 92, F444-F448.Wocadlo C, Rieger I (2006). Social skills and nonverbal decoding of emotions in very preterm children at early school age. European Journal of Developmental Psychology 3:1, 48-70.Wocadlo C, Rieger I (2006). Educational and therapeutic resource dependency at early school-age in children who were born very preterm. Early Human Development 82, 29-37.Wocadlo C, Rieger I (2007). Phonology, rapid naming and academic achievement in very preterm children at eight years of age. Early Human Development 83, 367-377.

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Research Projects 2006-2007 information as prospectively as possible. Each case of a stillborn baby will be compared to two live born control babies. The researchers will collect information by interview and samples for viral studies. We hypothesise that there may be modifiable risk factors identified by a detailed clinical history, that the perception of fetal movements may differ throughout pregnancy between cases and controls and that viral infection may play a role in stillbirth. The study commenced at RPAH in 2005 and now includes the Royal North Shore Hospitals (public and private), the Mater Hospital, Nepean and Westmead Hospitals. A further five Sydney hospitals are expected to be recruited in 2008.

Perinatal Mortality Audit at RPAHElizabeth Headley, Adrienne Gordon, Heather E JefferyClinical Practice Guidelines on Perinatal Mortality Audit were developed by a multidisciplinary group of clinicians for the Perinatal Society of Australia and New Zealand and published in 2005. The RPAH stillbirth policy was rewritten and updated to incorporate these guidelines. A detailed audit of the recommended investigations and practice for every perinatal death over a 30-month period was undertaken to identify compliance with recommended practice and any difference in cause of death classification.

Collaborative multicentre study on viral infection in stillbirth.Adrienne Gordon, Heather E Jeffery, William Rawlinson, Jonathon MorrisThe role of bacterial infection has been documented as particularly important in early stillbirths with a strong association between amniotic fluid infection and births before 28 weeks. Viral infection, in comparison, has been poorly described. Viruses are difficult to culture and positive serology does not prove causation. The more recent availability of molecular techniques, such as multiplex polymerase chain reaction (PCR) for identification of multiple viruses, may prove that viral infection has been a vastly underestimated cause of stillbirth. When similar tests were employed in a prospective post mortem study for SIDS, 43.5% of cases had evidence of viral induced myocarditis compared with controls that universally tested negative. Viral infections are being examined as part of our multicentre case control study on stillbirth. The investigations are undertaken by scientists at Prince of Wales Hospitals who aim to determine the prevalence, molecular events and transmission of pathogenic viruses in stillbirths.

Histological chorioamnionitis and fetal and neonatal outcomes.Monica M Lahra, Heather E JefferyThis study is focuses on the impact of chorioamnionitis on the fetus and neonate and its correlation with later, potentially preventable outcomes. Chorioamnionitis refers to both the clinical syndrome of intra-uterine infection and the histological processes that occur with it. Importantly, it is clinically silent in the majority of cases and is most accurately diagnosed by histological examination of the placenta, extraplacental membranes and umbilical cord after birth. Intrauterine infection is most commonly caused by ascending infection from the lower genital tract. Histological analysis shows evidence of initially a maternal then subsequently a fetal inflammatory response to ascending infection. This is associated with preterm birth. Using standardised, semi-quantitative

histopathological placental analysis, with very good inter- and intra-observer reliability between the principal pathologists, we found that there was a clear relationship between the presence of histological chorioamnionitis and preterm delivery that was inverse and approximately linear. In addition, we found that histological evidence of a fetal response to infection was associated with early survival after preterm birth. This study is examining the association between histological chorioamnionitis and preterm delivery and serious neonatal morbidity including respiratory distress syndrome.

Systematic reviews of use of specialised infant formulas for prevention of allergy and food intolerance.David Osborn, John Sinn.We are currently conducting two systematic reviews of the use of specialised infant formulas for prevention of allergy and food intolerance. The first review will focus on the use of a hydrolysed protein infant formula and a second review will focus on the use of soy milk formulas. The goal is to determine whether these specialised infant formulas can be recommended to mothers who are unable to solely breast feed so as to reduce the incidence of allergy and food intolerance, especially in those infants at high risk of allergy.

Prevention of low systemic blood flow and brain injury in very preterm babies using milrinone: A randomised controlled trial.Mary Paradisis, Nick Evans, David Osborn, Martin Kluckow Early low systemic blood flow (SBF) as measured by superior vena caval (SVC) flow is associated with intraventricular haemorrhage and abnormal neurodevelopment at three years. Risk factors for low SBF flow include lower gestational age and higher vascular resistance. Forty per cent of infants with low systemic blood flow fail to respond to commonly used inotropes. This two-centre study explores a preventative approach using milrinone (an inotrope and vasodilator) for very preterm babies (< 30 weeks) from early after birth. However, as there is a paucity of data on milrinone for the preterm population, the pharmacokinetics and optimal dose regimen needed to be determined. There was an absence of side effects and all babies maintained normal SVC flow while on the optimised dose of milrinone, compared to only 40% that would be expected to maintain flow, from historical data. This data on efficacy is encouraging but inconclusive. The aim of this two-centre RCT is to test whether we can prevent low systemic blood flow in preterm babies by giving milrinone soon after birth.

Influence of positive end expiratory pressure (PEEP) on Systemic Blood Flow: Koert De Waal, Nick Evans, David Osborn, Martin KluckowPositive pressure ventilation can limit venous return to the heart and so compromise systemic blood flow. In this observational study systemic blood flow was measured in preterm babies ventilated with a PEEP of 5 cms H20. The PEEP was then increased to 8 cms H2O for 10 minutes and the echocardiographic measures repeated before being returned to 5 cmsH20 with a final echocardiographic measure, 10 minutes later. The aim is to explore effect of this clinically used range of PEEP on systemic blood flow.

Acoustic environment of the NICU: a noise reduction projectSandie Bredemeyer, Lyndy Dixon, Jacki ShortSupported by the University of Sydney faculty of Nursing and Midwifery GrantSafe sound levels within the NICU are essential for the healthy development of the preterm infant. The immediate adverse responses of the preterm infant to excessive noise include episodes of apnoea, bradycardia, sudden fluctuations in blood pressure and oxygen saturation. The long-term effects, although not clearly defined, are postulated to contribute to behavioural problems frequently observed in preterm infants at follow up. Measurements collected randomly with a noise meter (Fluke Medical Systems USA) demonstrated that wide fluctuations in noise levels exist in our NICU over all time periods and the data clearly demonstrated a problem with excessive noise. The aim of this project is to reduce environmental noise in the NICU at RPA Women and Babies using an educational intervention with staff.

Use of chlorhexidine as a topical antiseptic for the prevention of nosocomial infection in preterm neonates < 29 weeks: a blinded randomised controlled trial.Sandie Bredemeyer, Ester Carman, Nick Evans, Shelley ReidSupported by a Research Grant from the Nurse Midwives Board NSWPreterm neonates are vulnerable to infection because of their immature immune system and the need for invasive procedures that compromise skin integrity. During invasive procedures, micro-organisms may be transported from the skin into underlying tissue or the bloodstream, which may result in an infection. To reduce this risk, the skin is cleansed with an antiseptic to remove micro-organisms prior to any procedure that will breach the skin. Because there is little research in the area, it is not known which antiseptic and what strength is best for use in premature neonates. Chlorhexidine is currently recommended as the best topical (skin) antiseptic available for adults and children. At RPA we currently use 0.015% chlorhexidine. By increasing the concentration of chlorhexidine from 0.015% to 0.5% we hope to demonstrate a reduction in the rate of nosocomial infection suffered by very preterm neonates.

Transcutaneous measurement of jaundice in the newborn: an evaluation of clinical accuracy in preterm infants. Sandie Bredemeyer, Jan Polverino, Phil Beeby, Sandra WestSupported by the University of Sydney Research and Development SchemeWhile transcutaneous bilirubinometers (TcBs) have been well validated in term infants their accuracy in the preterm population has not yet been clearly defined. Jaundice is more frequent and protracted in preterm infants and screening usually results in repeated and painful blood tests for this potentially high-risk group. This audit will establish the range of TcB readings that can safely replace invasive blood tests and thereby minimise the number of painful procedures in the premature newborn. Evidenced informed use of TcBs would reduce costs and decrease workload associated with current jaundice screening regimens. TcBs can provide immediate information about the infant’s response to treatment and reduce parental anxiety.

Systematic review of randomised trials of home visiting for women with a substance or alcohol problem.C Doggett, S Burrett, David Osborn. We are currently conducting a systematic review of randomised trials of home visiting for women with a substance or alcohol problem to determine the current evidence for antenatal and postnatal home visiting in this high-risk population. The goal is to develop a trial of social work and trained nurse home visiting in our area health service.

Echocardiographically-determined indomethacindosing: a randomised trial. Kathryn Carmo, Nick Evans, Mary Paradisis,David OsbornIt is observed that the ductus arteriosus (DA) is often closed or tightly constricted prior to the second dose in a course of indomethacin. Targeting infants with a haemodynamically significant duct, rather than treating all very preterm infants, would restrict indomethacin use and limit the possibility of potential side effects. This trial aims to determine whether in such cases further doses of indomethacin are necessary. Babies born before 30 weeks whose DA has not constricted at three hours receive indomethacin and are then randomised to either receive two further doses 24 hours apart or to receive those two further doses only if the DA has failed to constrict. The primary outcome will be successful closure of DA. The significance of this study is that dose minimisation will reduce the risks of potentially important side effects of indomethacin.

Epidemiology of Stillbirth in NSWAdrienne Gordon, Heather E JefferyStillbirth is defined in Australia as the loss of a fetus who shows no signs of life at birth and is at least 400 grams in birthweight or at least 20 weeks in gestation. This is a major public health problem and second only to preterm birth in its importance for prevention in the area of perinatal medicine. The current rate of 7.2 per 1,000 births is ten times the rate of SIDS and has remained fairly static for the past 20 years. Importantly, around 28% of stillbirths remain unexplained which is an issue both for families and treating clinicians. The classification of stillbirth in Australia and New Zealand was revised in 2002 to provide a uniform system for national use. Renamed the PSANZ Perinatal Death Classification in 2003, the system includes both obstetric and fetal factors as well as autopsy findings and placental pathology. It has high interobserver reliability with a kappa statistic from 0.83-0.95. This study uses linked deidentified data from the NSW Department of Health’s Midwives Data Collection and the Perinatal Death Classification databases. We aim to document both the descriptive epidemiology and risk factors for stillbirths on a population basis since the introduction of the PSANZ Perinatal Death Classification.

Prospective Multicentre Case-Control Studyof StillbirthAdrienne Gordon, Heather E JefferyMuch of the research on stillbirth is of large retrospective datasets. Although extremely useful when investigating risk for a relatively rare outcome there is often a large amount of missing information. This study will collect

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Presentations Jandera G, Mumford P. Use of human donor milk for high risk infants in the neonatal intensive care unit. Association of Neonatal Nurses of NSW 18th Annual Conference, Sydney 2007.

Lahra MM, Beeby PJ, Jeffery HE. The importance of inflammatory responses in stillbirth. Perinatal Society of Australia and New Zealand 11th Annual Congress, Melbourne 2007.

Lahra MM, Beeby PJ, Jeffery HE. Intrauterine inflammation and chronic lung disease. Perinatal Society of Australia and New Zealand 11th Annual Congress, Melbourne 2007.

Lahra MM, Beeby PJ, Jeffery HE. Intrauterine inflammation and respiratory distress syndrome. Perinatal Society of Australia and New Zealand 11th Annual Congress, Melbourne 2007.

Lahra MM, Gordon A, Jeffery HE. Chorioamnionitis in stillbirth: a new opportunity for prevention? “From Cell to Society” University of Sydney Health Research Conference, Leura NSW, 2006.

Lahra MM, Gordon A, Jeffery HE. Chorioamnionitis and fetal inflammatory response in stillbirth: A tertiary hospital cohort study. Federation of Asia and Oceania Perinatal Societies Congress, Bangkok, 2006.

Lahra MM, Gordon A, Jeffery HE. Chorioamnionitis and a fetal response in stillbirth: a 14-year cohort study (poster). Perinatal Society of Australia and New Zealand 10th Annual Congress, 2006.

Lahra MM, Gordon A, Jeffery HE. The importance of inflammatory responses in stillbirth. Perinatal Society of Australia and New Zealand 11th Annual Congress, 2007.

Malcolm G. Hoc Mai Foundation workshop on small group teaching methods. National Hospital for Paediatrics, Hanoi, Vietnam 2007.

Malcolm G. “Train the trainer” workshop for advanced trainees. Universiti Sans Malaysia & University of Sydney, Kota Baru, Kelantan, Malaysia 2007.

Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Perinatal Society of Australia and New Zealand 11th Annual Conference, 2007.

Osborn DA, Evans N, Kluckow M. Do extremely premature infants maintain the proportion of systemic blood flow (SBF) going to the brain and upper body in the 1st day? (Poster). Perinatal Society of Australia and New Zealand 11th Annual Conference, 2007.

Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. (Poster). Perinatal Society of Australia and New Zealand 11th Annual Conference, 2007.

Osborn DA. Beyond iodine deficiency: Is hypo-thyroxinaemia in pregnancy and the newborn another threat to children’s intelligence? Panel Discussant. Westmead International Update on Controversies in Perinatal Care, Westmead Hospital, Sydney 2007.

Paradisis M, Evans N, Kluckow M, Osborn DA. Randomised trial of milrinone versus placebo for

prevention of low systemic blood flow in very preterm infants. Perinatal Society of Australia and New Zealand 11th Annual Conference, 2007.

Paradisis M, Evans NJ, Kluckow M, Osborn DA. Randomised trial of Milrinone to prevent low systemic blood flow in very preterm babies. Pediatric Academic Society Meeting, Toronto, Canada 2007.

Polverino J, Batchelor C, Bredemeyer S, Davey J, Reid S. What neonatal nurses really think - ANN survey. Association of Neonatal Nurses of NSW 17th Annual Conference, Sydney 2006.

Rawlinson WD, Howard J, Jones CA, Arbuckle S, Hall B, Leader LR, Gordon A, Jeffery H, Morris J. Viral aetiology of stillbirths. Perinatal Society of Australia and New Zealand 11th Annual Congress, 2007.

Ryan M, Bredemeyer S, Desreaux C. safe sleeping and the prevention of SIDS: the role of the midwife and nurse. (Poster). Association of Neonatal Nurses of NSW 17th Annual Conference, Sydney 2006.

de Waal KA, Evans N, Osborn DA, Kluckow M. Effect of changes in end expiratory pressure on brain and upper body blood flow in ventilated newborns. European Society for Paediatric Research Annual Conference 2006.

de Waal KA, Evans N, Osborn DA, Kluckow M. Effect of changes in end expiratory pressure on brain and upper body blood flow in ventilated newborns. Perinatal Society of Australia and New Zealand 10th Annual Conference, 2006.

de Waal KA, van Veenendaal MB, Evans N, van Kaam AHLC. Effect of Lung Recruitment on Pulmonary and Systemic Blood Flow in Preterm Infants. Pediatric Academic Society Meeting, Toronto 2007 and Perinatal Society of Australia and New Zealand 11th Annual Scientific Congress, Melbourne 2007.

Wocadlo C. Hop, skip and read: Learning and motor skills in very preterm children. Preterm Babies and Children Information Day, Australian Physiotherapy Association, Sydney 2007.

Awards

Monica Lahra.

“From Cell to Society” University of Sydney Health Research Conference, 2007.

First runner-up: best presentation in category of ‘Prevention’.

Monica Lahra

SIDS & Kids Research Scholarship, 2007.

Awarded for support of PhD study.

Monica Lahra

Australian Society for Infectious Diseases John Forbes Developing Nations Travelling Scholarship 2007.

Awarded for travel to Vietnam to participate in the Hoc Mai Foundation Dien Bien Project aimed at reducing perinatal morbidity and mortality in Northern Vietnam (see also page 18).

Invited Plenary Speaker

Bredemeyer SL. Do preterm babies need polyethylene wrap for thermal management at birth? Australian Resuscitation Council International Conference, Gold Coast 2007.

Browning Carmo. Case study: Feed thickeners - friend or foe? Association of Neonatal Nurses of NSW 17th Annual Conference, Sydney 2006.

Evans N. Breakfast Workshop on Neonatal Echocardiography. Perinatal Society of Australia and New Zealand 10th Annual Scientific Congress, Perth 2006.

Evans N. Preterm Circulatory Compromise: Which Inotrope in Which Baby? Pediatric Academic Society Meeting, San Francisco 2006.

Evans N. Symposium on Neonatal Echocardiography. Cape Town, South Africa 2006.

Evans N. Advances in Neonatology. Cartagena, Columbia 2006.

Evans N. Hammersmith Neonatal Update, London UK 2006.

Evans N. Eric White Visiting Professor. Toronto Hospital for Sick Children, Canada 2006.

Evans N. Milrinone for Prevention of Low Systemic Blood Flow. Neonatal Haemodynamics Club, Pediatric Academic Society Meeting, Toronto, Canada 2007.

Evans N. Symposium on the Ductus Arteriosus. Tours, France 2007.

Evans N. Neonatal Symposium. Santiago, Chile 2007.

Gordon A. Investigation of stillbirth. 12th Advanced Course in Obstetrics, women’s reproductive health and care of the newborn. RACGP July 2006.

Gordon A. A Picture of stillbirths in NSW 2002-2004. SIDS and KIDS SIDS and Stillbirth Symposium. Perth 2006.

Gordon A. The community burden of stillbirth. 3rd Conference of the International Stillbirth Alliance SIDS and KIDS Stillbirth Symposium. Sydney 2007.

Jeffery HE. Sudden unexpected death in infants. National CDC Workshop, Boston USA 2007.

Jeffery HE. Reducing infant mortality: An evidence-based approach. 11th National Conference on Medical Science, Malaysia 2006.

Lahra MM, Gordon A, Jeffery HE. Chorioamnionitis and a fetal response in stillbirth: a 14-year cohort study. Satellite meeting at the Perinatal Society of Australia and New Zealand 10th Annual Congress, 2006.

Lahra MM. Inflammation, infection and stillbirth. 3rd Conference of the International Stillbirth Alliance SIDS and KIDS Stillbirth Symposium. Sydney 2007.

Osborn DA. Neonatal abstinence syndrome. Association of Neonatal Nurses of NSW 17th Annual Conference, Sydney 2006.

Osborn D. Systematic reviews of thyroid hormone therapy and antenatal TRH in the newborn. Beyond iodine deficiency: Hypothyroxinaemia in pregnancy and the newborn. Should we screen and treat? Workshop. Westmead Hospital, NSW 2007.

Osborn DA. The cardiovascular system: assessment by ultrasonography. European Society for Paediatric Research Annual Conference 2007. Prague, Czech Republic.

Osborn DA. Neonatal hypertension. NEOCON 2007 Conference, Pune India.

Osborn DA. Choice of inotropic agents. NEOCON 2007 Conference, Pune India.

Rieger I. Long term outcomes at RPA. Association of Neonatal Nurses of NSW 17th Annual Conference, Sydney 2006.

Wocadlo C. From neuron to nuance: Development and cognitive science. Association of Neonatal Nurses of NSW 17th Annual Conference, Sydney 2006.

Wocadlo C. From neuron to nuance: Development and cognitive science. Tasmanian Neonatal Nurses Association Annual Conference, Launceston, Tasmania 2007.

Presentations

Bredemeyer SL. The NSW neonatal CNC Network: a collaborative practice model. SSWAHS Advanced Practice Nurses’ Forum, RPAH, 2006.

Bredemeyer SL. Prevention of SIDS - role of the midwife. Nepean Midwives Conference, Richmond NSW, 2006.

Bredemeyer S, Carman E. Informed consent and perinatal research. Association of Neonatal Nurses of NSW 17th Annual Conference, Sydney 2006.

Bredemeyer SL, Carman E, Evans N, Reid S. Use of chlorhexidine as a topical antiseptic in the premature infant less than 29 weeks: a blinded RCT. “From Cell to Society” University of Sydney Health Research Conference, Leura NSW, 2006.

Bredemeyer SL. IVH in the preterm infant: aetiology and management. RPA Inaugural Neurosciences Day, RPAH, 2007.

Bredemeyer S, Polverino J, Beeby P, West S. Transcutaneous measurement of jaundice in the newborn: An evaluation of clinical accuracy in preterm infants. Association of Neonatal Nurses of NSW 18th Annual Conference, Sydney 2007.

Gordon A, Jeffery H, Taylor L. A picture of stillbirths in NSW 2002 - 2004. Perinatal Society of Australia and New Zealand 10th Annual Congress, 2006.

Gordon A, Jeffery H, Lahra MM. Intrauterine inflammation and stillbirth in NSW. International Stillbirth Alliance 3rd Annual Conference. Birmingham, 2007.

Gordon A. Lahra MM, Taylor L, Jeffery HE. A population based study of histological chorioamnionitis in stillbirths in NSW. Perinatal Society of Australia and New Zealand 11th Annual Congress, Melbourne 2007.

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Educational Achievements DHS: a tribute

David Osborn

Very preterm infants are at high risk of brain injury. In 2006 David Osborn was awarded Doctor of Philosophy from The University of Sydney for his thesis, “The haemodynamic basis of peri/intraventricular haemorrhage and cardiovascular support of the preterm infant.” His studies looked at how low body and brain blood flow in the first day may lead to subsequent peri/intraventricular haemorrhage and other negative outcomes such as necrotising enterocolitis, retinopathy of prematurity, mortality and neurodevelopmental impairments at 1 and 3 years. The causes of low body blood flow were explored and David found risk factors including extreme prematurity, large diameter ductus arteriosus in the first day, mechanical ventilation with higher mean airway pressures, higher body vascular resistance and poor myocardial contractility.

The effects of indomethacin versus placebo for infants with an early, large diameter ductus arteriosus (DA) were also examined and David found that closing an early large ductus did not result in improved body blood flow in most infants, and the smallest infants tended to decrease body blood flow after indomethacin. In infants with low body blood flow, volume expansion and dobutamine increased body blood flow better

than volume and dopamine, which rather tended to increase blood pressure and vascular resistance. David found that extremely preterm infants who developed low body blood flow had worse myocardial contractility than infants maintaining normal blood flows. However, neither the commonly used agents used to support the circulation increased myocardial contractility (dobutamine or dopamine). This research has important implications for commonly used treatments in newborn infants and future research.

Emeritus Professor David Henderson-SmartAO, PhD, MBBS, FRACP, FRANZCOG (Hon)

After a period of postgraduate research at Oxford University David Henderson-Smart returned to RPA as Staff Specialist in Neonatology in 1979. Together with Dr Bruce Storey, he provided the foundation on which our current department was built. It is impossible to overstate the importance of the contribution that Professor David Henderson-Smart made to the development of Fetal and Neonatal Medicine at RPA Hospital.

Clinically, he was always a strong advocate for health services being provided for the benefit of patients, not for those who provide the services, particularly doctors. Further to this, he recognised that the best outcomes for patients are achieved when people work together in teams with common goals rather than working as individuals in competition with each other. This emphasis on team work was manifested in achievements at several levels. Within the John Spence Nursery, he promoted an environment where the importance of all the professional groups was recognised. This included apparently minor routines that we still follow such as the nurse not the doctor presenting the baby on the afternoon ward round. This equal recognition of the input of nursing and medical staff into clinical decision making extended (and still extends) to major decisions about protocols and procedures. At a hospital level, he recognised that life does not begin at birth and the need for close collaboration between those looking after the fetus before birth (the obstetricians and midwives) and those caring for the baby after birth. The bringing together of Fetal and Neonatal Medicine under one Department of Perinatal Medicine was part of this process. This departmental structure hasn’t been sustained but the atmosphere of collaboration has and there are regular and close multidisciplinary consultations about high risk pregnancies.

At a state level, David was one of the instigators and the founding Director of the NSW Perinatal Services Network. Under his guidance, perinatal care in NSW moved from being isolated hospital services that worked independently of each other, into a collaborative network. At a national level, he was one of the founding members of the Australian and New Zealand Neonatal Network, a collaboration of all the tertiary NICUs in both countries. Both these networks are still thriving though it is testament to the importance of his contribution that there have been transitional pains in both since David’s retirement.

The other great facet of David’s contribution to RPA was his leadership and promotion of research. Initially this was basic science and clinical research within RPA but this developed into multicentre clinical trials

and then his work with the Cochrane Collaboration. He was a member of the group which established the initial principles of the Oxford Database of Perinatal Trials, the forerunner of the Cochrane Collaboration. He always promoted the importance of using the best available evidence in deciding how we should care for sick newborn babies.

After his appointment as Director of NSW PSN in 1992, he continued a clinical role at RPA but he dropped this after a few years when NSW Health fully funded his position. In 1996 he coordinated his range of major academic and service interests into the NSW Centre for Perinatal Health Services Research. He continued in this position until November 2007.

His contribution to RPA Neonatology continued through his research activity, protocol development and teaching. At a personal level, David has been a great mentor and role model to many neonatologists, including myself. He gave space when it was needed and support when it was required. I know that there are many in perinatal medicine, like me, who owe much of what they’ve achieved to David’s support.

In 2006 Professor Henderson-Smart was appointed Officer of the Order of Australia (AO) for service to medicine in the fields of neonatal and perinatal care as a clinician, researcher, administrator and educator. He retired at the end of 2007. His counsel has been badly missed by us since his retirement; on the other hand, there is an entire hillside in southern Tasmania that has been planted with grapes by him and, on a recent return visit, we got to taste one of the first vintages and it was pretty good. David and Cheryl are clearly thriving in their well deserved retirement.

Nick Evans.

Kirsty Foster

The year 2000 was memorable for the Olympic Games in Sydney and also for the arrival of Dr Kirsty Foster. Kirsty worked as the medical educator in the department after arriving early in that best Olympic year, until 2007. During that time she was integral in the development and advancement of inter-professional education within the department, fostering (pun intended) cross-professional communication and supporting medical student education. She was also an essential oil in the department’s social gearbox.

Kirsty arrived from Scotland via Africa where she had been working with UNICEF. Prior to that she had a distinguished career in Edinburgh as a primary care physician, post graduate educator and advisor on public health promotion to the local health board.

Kirsty’s interest in medical education has seen her play a leading role in the development of the Sydney University post graduate medicine curriculum and her contributions ensured that the Women & Children’s rotation was consistently rated highly by the medical students.

During her tenure, Kirsty was instrumental in expanding the educational role of the department, coordinating and participating in our outreach education sessions in country NSW hospitals as well as urban facilities. Not content with the parochial she also had responsibilities

for outreach abroad in places such as the Republic of Macedonia, Croatia, East Timor, Vietnam and Malaysia.

Kirsty was instrumental in the expansion and concretion of the Post Graduate Education program (PEP) which has helped ensure that RPA Newborn Care continues to be amongst the first rank of training venues for junior medical staff, nurses and allied health professionals both locally and from overseas.

It is well known, however, that you cannot keep a good woman down on the farm once she’s seen Paris or in this case North Sydney. In February 2007 Kirsty was elevated (literally and metaphorically) to the position of Senior Lecturer in Medical Education at the Northern Clinical School of the University of Sydney. The staff of RPA Newborn Care thank Kirsty for her invaluable contributions to the department and wish her well for the future.

David with his son Jack

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Dr Monica Lahra (R), with laboratory personnel at the Provincial Hospital. Monica, a Pathologist trained in Microbiology, undertook a needs assessment with the aim of assisting with development of a modern a regional laboratory.

Heather Jeffery with a Vietnamese family

Louise Corcoran (R) teaching in Vietnam in 2007

Demonstration at Dien Bien Provincial Hospital, March 2006. Enactment of neonatal resuscitation at beginning of SCORPIO teaching. Heather Jeffery (L) narrating, Adrienne Gordon (centre) leading with Kerry Watson (R).

David Osborn (standing) teaching in Vietnam in 2007

International Education in Maternal and Neonatal Care

Role of Department of Neonatal Medicine,Royal Prince Alfred Hospital

The staff from RPA Newborn Care have made a significant contribution utilizing their educational expertise through

innovative educational initiatives developed over the last decade, in particular the success of a medium for teaching using modern educational methods contained within the acronym Structured, Clinical, Objective-Referenced, Problem oriented, Organised (SCORPIO), developed and refined by Dr David Hill while at RPAH. It is an excellent medium to teach skills and problem solving to small, interactive groups and has proven successful in changing the behaviour of clinicians. In 2006 and 2007 this educational expertise was

transferred to both Vietnam and Malaysia. RPAH became involved in Vietnam through the Hoc Mai Foundation, a not-for-profit charitable foundation under the auspices of the University of Sydney, and in Malaysia through the International Development Program and the Universiti Sains Malaysia University of Sydney postgraduate program.

VIETNAM

Maternal and Child Health Project, Dien Bien Phu

The Dien Bien Province is located in the remote, mountainous north-west region of Vietnam and shares its 395 km border with China, Laos and Cambodia. The province has 8 districts, 88 communes and one provincial town, Dien Bien Phu, which is located approximately 500km west of Hanoi and is home to over 450,000 people. Over 70% come from one of 21 ethnic minority groups (19% Vietnamese, 40% Thai, 29% Hímong). Each group has a different language and cultural beliefs. Literacy rates and educational levels are among lowest in the country.

The estimated maternal mortality rate in the Province (441/100,000) is significantly higher than the overall MMR for Vietnam (100/100,000). Up to 50% of women living in the mountains (most belong to an ethnic minority) deliver at home. This reflects both lack of education and lack of access to health services in this isolated region. Frequently observed pregnancy complications include haemorrhage (the main cause of maternal death), hypertension and infection for which there are cheap, effective and easily taught interventions.

Mortality rates for infants less than 12 months (53/1000) and for children 1-4 years (63/1000) are also amongst the highest in Vietnam. These figures are likely to be underestimated because there is acknowledged systematic under-reporting of deaths that occur outside health facilities. For neonates, birth asphyxia, low birth weight, neonatal sepsis and hyperbilirubinaemia are common. In childhood, malnutrition occurs in 30% and malaria, tuberculosis, parasite infection, injury and accidents are major problems.

In the province there is a high level of dependence on free health care, inadequate funding for equipment and medications, and lack of access to simple laboratory methods. Referral processes are poorly established from village to higher level health care facilities. There are few opportunities for post-graduate education.

In March 2006, nine health professionals, four from RPAH (A/Prof Heather Jeffery, Dr Adrienne Gordon, Dr Kirsty Foster, Nurse Educator Kerry Watson) joined team leader Prof Elizabeth Elliott from Paediatrics and Child Health at Westmead Hospital and others to build on a prior pilot needs assessment in 2005 in Dien Bien Province. Three-day workshops embracing the SCORPIO method were conducted in the provincial hospital for doctors, midwives and nurses working in obstetrics, neonatology or paediatrics from the district and commune levels, under the guidance and support of the Director Dr Luong Duc Son. Assisted by interpreters from National Hospital Paediatrics, Hanoi and UNFPA, Hanoi, topics addressed the common causes of death in mothers and babies and included neonatal resuscitation, prevention of infection in the newborn and management of anaemia and the third stage of labour.

In November 2007, a multidisciplinary group of doctors, nurses and midwives, led by Prof Liz Elliott spent four days using SCORPIO teaching to provide educational opportunities not otherwise available for health providers

in remote Vietnam. In all we developed and delivered a tailored, interactive, skill-based, small group educational program to 60 clinicians throughout Dien Bien Province. RPAH was represented by four teachers, Dr Monica Lahra who won a scholarship from the Royal Australian College of Pathologists to evaluate Pathology services in the province, and A/Prof Heather Jeffery, Dr David Osborn, and Clinical Nurse Specialist Louise Corcoran.

Both workshops in 2006 and 2007 were supported by a grant from the International Project Development Fund of the University of Sydney and Hoc Mai Medical Foundation.

Vietnam February 2007

The Director of the National Hospital for Paediatrics (NHP) in Hanoi, Prof Nguyen Thanh Liem requested a Train-the-Trainer program for doctors and nurses at NHP in line with modern skills based training. A team of eight undertook this successful project which was led by Prof Heather Jeffery with Dr David Hill, Dr Girvan Malcolm, Dr Kirsty Foster and Clinical Nurse Specialist Jan Polverino, all from RPAH. The United Nations Population program was interested to observe and this led to the implementation of SCORPIO teaching in Vietnam to address the needs of mothers and babies through UNFPA and the Ministry of Health.

Vietnam June 2007

The United Nations Population Fund (UNFPA) Hanoi engaged the services of the University of Sydney (Hoc Mai Medical Foundation) in order to conduct the training for National Trainers on Emergency Obstetric Care (EmOC) and Newborn Care (EmNBC) under the Ministry of Health. The services were provided within the framework of the 7th Country Program (2006-2010) between UNFPA and the Vietnam Government.

Professor Heather Jeffery was the Neonatal Consultant and team leader for the program held in Hanoi at the National OBYG Hospital with A/Prof David Osborn and Clinical Nurse Specialist Louise Corcoran from RPA Newborn Care. The team with obstetricians and midwives were engaged for one week in delivering SCORPIO as a means to rollout the basic skills in obstetric and neonatal care in order to reduce the high maternal and neonatal mortality in the seven poorest provinces in Vietnam. Dr David Hill, previously from RPAH, was the Medical Educator who designed and evaluated

the program. The evaluation suggests that the program demonstrated the value of inter-professional teaching and learning, the flexible nature of small group SCORPIO teaching and the relevance and applicability to tertiary, provincial, district and even commune service providers.

Emergency Obstetric Care (EmOC) and Emergency Newborn Care (EmNBC) trainers responded well to the challenge of developing small group educational SCORPIO stations, demonstrated an ability to introduce new innovative forms of teaching and the ability to identify the enablers and barriers to the introduction of SCORPIO teaching. Further capacity building is essential for sustainability and EmOC and EmNBC trainers will require further assistance in learning and teaching

MALAYSIA

University of Sydney and RPAH have had a long relationship with the Universiti Sains Malaysia (USM) since the commencement of the Medical Faculty at USM in 1980.

In November 2007, Professor Rogayah Zaini, an international leader in education and Head of Medical Education at USM, invited us to run a SCORPIO Train the Trainer workshop at USM in the skills laboratory. An experienced RPAH team joined colleagues at USM for the 6th National Course on effective Postgraduate Teaching and Assessment. Participants were doctors from Government and University institutions around Malaysia. Teachers included team leader A/Prof Heather Jeffery, A/Prof Janet Vaughan and A/Prof David Osborn, Dr Girvan Malcolm and Dr Dominic Hill. Medical Educator Dr David Hill developed the program. The workshop was evaluated as highly successful and certainly very enjoyable. The illustrations reflect that teaching and learning can be simultaneously fun and effective.

20 21

Newborn Family Support TeamActivity for 2006-2007

2006 2007

Discharge planning occasions 571 809

Home visits 633 819

Parent-initiated phone calls 172 115

Nurse-initiated phone calls 1066 1591

Transfers back to other hospitals

161 132

Direct client care (hours) 201 270

I have had the pleasure of working in RPA Newborn Care for the past four years and most recently jumped

at the chance to see what happens when our babies go home by working as part of the Newborn Family Support Team (NFST).

NFST helps to ‘bridge the gap’ between hospital and the big wide world, providing phone and home visiting support for families in our area and is also involved with the transfer of babies back to peripheral hospitals near where their family lives.

After varying journeys through Newborn Care, our babies graduate to the Special Care Nursery for ‘fattening up’and to get ready for home. During this time the NFST works alongside parents, discussing what to expect once their baby is home, including sleepless nights, unsettled periods and of course the fun stuff such as playtime and outings. Weekly parent talks are held by a member of the NFST covering various topics including home safety, what to expect with baby at home and sometimes graduate babies and their parents who come back and share their experiences.

The opportunity to visit families in their own home is a special part of the NFST role. After long weeks or months in the nursery, parents may need extra reassurance once at home that they are doing the ‘right thing’ by their baby and making the best decisions they can. Contact begins early, with a phone call checking the parents got through the first night at home with their baby without too much stress. Home visiting then usually begins from the third day at home or earlier if needed and continues for several weeks or until families are ready for transition to the care of the Early Childhood Centre. One of the great benefits I found of working with families in the community is developing a friendly rapport and the ability to provide more one-to-one focused support and care whilst in their home. I looked forward to visiting my families, having a cup of tea and catching up on what their baby had been up to. We spent a fair amount of time talking about feeding and sleep and settling techniques and how to survive on a few hours sleep at a time. More often than not the parents had everything fairly well under control and simply needed some reassurance that they were ‘doing the right thing’ and their baby was thriving since being at home. However some of our more complex babies and families need continued input from lactation consultants, physiotherapist, speech therapist and social work once at home and this can be easily facilitated as outpatient appointments or joint home visits.

The 24-hour paging service provided a great deal of reassurance for new parents, knowing that they could get in touch with a member of the team at any time, day or night. And of course the availability of the team

sometimes leads to middle-of-the-night phone calls ranging from “what is a normal poo?”-type questions to providing reassurance of normal baby behavior to advising parents to take their baby to their closest Emergency Department for further assessment.

Back transfers were always an interesting experience. The flurry of organizing a bed at the receiving hospital, assessing if the baby is fit for travel and ensuring the parents were happy to be transferred was challenging at times. However once we had safely arrived at the receiving hospital, it was always worth it when the parents realized they were 5 minutes from home instead of a 2-hour drive to visit their baby.

A fun part of working with NFST is definitely the Baby Play Gym. The BPG is run by the NFST over a 6-week period with a different topic each week, such as sleep and settling techniques, baby massage and infant resuscitation. It’s a great opportunity for mums and dads to bring their baby along, catch up with other parents and obtain valuable information from the various guest speakers. The Baby Play Gym Christmas party is also an event not to be missed! All the babies from the year’s groups are invited back to celebrate the season and it’s amazing to see the progress they all make.

Working with the NFST opened my eyes to the other side of life outside the nursery and the rollercoaster ride that many of our parents may continue to experience once at home. Visiting families and being welcomed into their homes at a very special time was a unique and rewarding experience and truly enjoyable knowing I had helped ease the transition from the nursery to home.

Kelly Leven

Newborn Family Support Team Developmental Follow Up

The follow up team was very lucky to acquire the very capable Claudia Schwatlo, our new co-coordinator

in 2006. Claudia is a very experienced midwife who has worked in several different continents and we are delighted to have her as part of the team. After having had a vacancy for our physiotherapist for some time, in April 2006 Danielle Hinwood joined the team. Danielle comes with an enormous amount of experience in paediatric physiotherapy, having most recently worked with the Spastic Centre of NSW. Danielle’s role is mainly with the younger babies, assessing them and providing a therapy service for those who need some extra help with their motor development.

Our fellows in 2006 were Dr Adrienne Lynn and Dr Katherine Carmo. Adrienne had come from New Zealand to complete her advanced training in neonatology and returned to take up a position as a staff neonatologist in Christchurch. Kath completed her training here and is working as a neonatologist both for the Neonatal Emergency Transport Service and The Childrenís Hospital at Westmead. In 2007 another fellow from New Zealand, Bronwyn Dixon, spent some time in the clinic. Bronwyn is now a neonatologist in Christchurch.

During 2006 and 2007 Dymocks Booksellers continued to sponsor our book and reading program for the children in the Silver Star Clinic. The children really enjoy receiving a book at the completion of their assessment and this reinforces for their parents the importance of reading and talking to their children. We are hoping in the future to extend the program to the older children, and perhaps even to all of the children who have spent time in Newborn Care.

In 2006 Crista Wocadlo supervised the post-graduate training in psychometric assessment of two psychologists, Molly Schaffer and Julia Weinstein. Various members of the team participated in educational activities during 2006 and 2007. Ingrid and Danielle went to Brisbane for a conference on cerebral palsy and Ingrid went to Melbourne for a general medical update at Monash Medical Centre.

The staff of the hospital and community health services in Griffith were very happy to host a talk about outcomes for preterm children when the team visited Griffith for a follow up clinic. Crista continued her regular and very comprehensive talks at The College of Nursing and for the staff of NICU at RPAH.

Dr Bronwyn Dixon checks the height of Gabrielle Clifton, aged 3 years

Danielle Hinwod (L) and Claudia Schwatlo

Dr Kath Carmo performing part of the 5 year assessment with India Holman

22 23

Farewell Amanda Durack Welcome to Dahlia

Amanda Durack left her position as fundraising coordinator for Friends of RPA Newborn Care in

2006 after 10 years in the position.

I first met Amanda in 1994 at a thank-you morning tea for donors to an appeal that the hospital public affairs and marketing department had run to raise funds for a new incubator. Amanda and her husband, Phillip, had been donors to the appeal. After the presentation, Amanda and I talked about the problems of getting funding for the vital equipment that we needed. At that time our fundraising activities were in the doldrums. In the early 1990s, our fundraising had been organised by our senior nurses but management consultants and economic rationalism had cut a swathe through our nursing numbers and put paid to these efforts.

This must have planted a seed of an idea in Amanda because two years later she made an appointment to come and see me. She proposed the idea of acting as a fundraiser for the department on a part-time basis. During the intervening two years our fundraising had gone from bad to worse and we jumped at the offer. Amanda had a professional background in marketing in the cosmetic industry which made her well suited to the role, though I do remember spending some time warning her about the frustrations of dealing with the lumbering bureaucracy of a large public hospital. Initially it was a steep learning curve for all of us but the funds started to come in through generous donations from appeals driven by Amanda to our parents and many charitable foundations. Intensive care monitors, resuscitaires and ventilators that dated from the early

1980s were replaced, monitors in the high dependency area were replaced, a new ultrasound machine was purchased. The list goes on and on and over the 10 years that we were privileged to have Amanda as part of our team, over two million dollars were raised to make sure that we have the very best possible equipment to care for the babies.

But Amanda’s role went beyond fundraising. As an ex-parent we sought her advice constantly to get a ‘consumer’ perspective. We prepared an information booklet on outcomes for preterm babies for parents and prospective parents. Amanda took our clumsy over-medical first draft and converted it into a document that clearly communicated difficult issues for parents at a time of great stress. When we were designing our new intensive care unit, we consulted Amanda to get a parent’s perspective on what we were proposing. The parents’ facilities in the new unit were the result of Amanda’s design and fundraising skills. Again the list goes on.

We wish Amanda well in the new challenges that she’s moving on to but the fundraising model that she created continues. Dahlia Brigham took over Amanda’s role in late 2007. Dahlia’s grandson, Hugo, spent his first few days in our nursery. Dahlia has a background in fundraising and is already stamping her mark on this vital role within our service.

A/Prof Nick EvansHead of DepartmentRPA Newborn Care

I started working at RPA Newborn Care in October 2007, several months after Amanda left. However

my initial introduction to this very special place was two years earlier when Hugo, our first grandchild was born.

The birth of a grandchild, especially your first, is one of the biggest joys one can experience. Unfortunately, Hugo’s traumatic birth is what led my family and me to RPA Newborn Care and introduced us to an exceptional team of dedicated and world class professionals. Unlike most babies in the neonatal intensive care unit, Hugo was not premature and was transferred from another hospital. Due to complications during birth he was not breathing after delivery and needed to be revived. The condition, which occurs in one in a 1,000 births, is known as hypoxic ischaemic encephalopathy (HIE) and results from a lack of oxygen to the brain. Within hours of his birth, the NETS team transported Hugo to RPA Newborn Care where the highest level (level three) of neonatal intensive care is provided. Hugo’s story is included in this publication.

We are extremely grateful and feel very blessed that Hugo is now a healthy, bright and beautiful toddler. He is (as you may have guessed) the apple of our eyes!

As you know, RPA Newborn Care greatly relies on your support and generosity to purchase much needed life saving equipment and fund important projects and programs. Like Hugo, half the babies we care for in our neonatal intensive care unit are transferred from other hospitals in Sydney and NSW. Without your support very little can be provided to assist the exceptional

team whose sole objective is to save the lives of very ill babies and provide them with the best possible start in life.

I look forward to the opportunity of meeting you someday; in the meantime please do not hesitate to contact me on 9515 8456 if you require any information or if I can be of any assistance whatsoever.

Thank you so much for your loyalty and ongoing generous support of RPA Newborn Care.

Dahlia Brigham dahlia.brigham@sswahs.nsw.gov.au

Dahlia & Hugo, 2008

Amanda with certificate of appreciation

Amanda with Lyndy Dixon and Simon Burke

International VisitorsIn the years 2006 - 2007, several international visitors

came as clinical observers to learn skills in neonatal ultrasound with Assoc. Professor Nick Evans. These included Dr Tina Leone from the Neonatal Dept at the University of California, San Diego Medical Center, who spent a month at RPA learning these skills. Tina has continued to develop these skills in San Diego and is now actively teaching neonatal ultrasound on their Fellowship program.

Dr Simone Figueira who was a neonatal fellow from San Paulo in Brazil spent four months at RPA and has also been developing these skills since her return to Brazil. It is always a two-way exchange with international visitors. We hope they learn something from us but we always learn something from them.

Dr Simone FigueiraDr Tina Leone

24 25

Friends of RPA Newborn Care

We acknowledged the very significant donation by Sargents Pty Ltd at an afternoon tea. Pictured is

Head of Department Assoc. Prof Nick Evans (R) with representatives from the company who accepted a crystal plaque and flowers from Friends of RPA Newborn Care. This donation enabled the purchase of a special ultrasound machine that is used to scan the hearts of newborns, looking at how they are functioning and if treatment is required. Some conditions can be picked up and treated early before clinical signs are obvious and this means better outcomes for babies.

Once again McDonalds donated very generously. Pictured is Dr David Osborn (R) accepting the very generous donation from McDonalds representatives.

Thanks go Shirley Butler for the exquisite patchwork quilts and knitted baby clothes. Shirley has made two quilts for RPA Newborn Care. The quilts have been raffled to give everyone the opportunity to own such a beautiful work of art. The latest quilt “Clowning Around” (pictured) depicts bright and playful clowns surrounded by animals. The knitted baby clothes are beautiful and the nursery is now well supplied with them. If anyone

else would like to donate their time and expertise, the nursery is always in need of colourful sheets for the humidicribs (as seen in the pictures on pages 4 and 6). Please contact the nursing staff for more information.

Thanks also to Paula and Kirk Tsihlis for their very generous gift which allowed us to purchase a much needed Breast Milk Pasteuriser. Their twins Paul and Georgia were cared for at RPA Newborn Care. The donor milk program at RPA Newborn Care was introduced in 2005 specifically for the benefit of the very tiny, fragile preterm infants who need it.

As mentioned on page 21, we would also like to thank Dymocks Booksellers for their ongoing and very generous donation of books that are given to children as they progress through the Developmental Follow Up clinic.

Donations were given in memory of:

Flo Spinucci

Jennifer Lee

DonorsOver $200,000Sargents Pty Ltd

DONORS $10,000 - $50,000Australian Stockbrokers FoundationKoveos, PaulaMcDonald's Australia LimitedSiemens LimitedWoods, M

DONORS $5,000 - $9,999Bowlers Club of New South WalesPetersham RSL Club LimitedSpinucci, Brett

DONORS $1,000 - $4,999Anderson, GailConnellan, GCurley, Stephen & MargaretDobbin, JeremyFisher & Paykel HealthcareFugen Constructions Pty LtdKizilcik, ShirleyKorompay, MichaelPerdis, Soula - MarieSarma, KamalSnell, DavidTilley, WTornaros, DonWyeth

DONORS $500 - $999Anderson, RobBell, RossDillon, HughDouglas Pharmaceuticals

Fatouris, MichaelFyfe, SieglindHarman, MirandaIvers, GeorginaKant, AdamLinton-Frost, MrsLockhart, BMcNally, A & LMoyle, Nathan & HelenNastevski, MrRockdale City CouncilShum, Rose MThe College of NursingWheeler, J

DONORS $100 - $499Adare, JaneAddinall, WAlibrandi, AldoAllon, LucyBarker, Rowan RBarraclough, RogerBarry, Joe & CathieBatchelor, CBayari, Fatma IlknurBoniolo, StefaniaBreheny, M & SBremner, A & CBretag, DanielBroadbent, TraceyBrooks, Kerry & EthneeBrowne, D & BBurrel, Kym & SandraButcher, F & BButtsworth, G & SCarden, JoanCarswell, LCathels, C CChaloner, PaulChander, SudeshCheltenham Girls High SchoolConstantiCooper, AnneCooper, JaneCornwell, GeraldineCummins, Paul ADay, A & KD'Emilio, JohnDennis, Joy & MichaelDixon, FionaDunstone, SophieEdgoose, TrevorEl-Chami, RhondaEllis, JaneElmslie, Alan RFoster, L & SGardiner, CarolynGellieGoodridge, J & RGriffiths, BJ & BGHamilton, Kathy

Hardiman, B & THarvey-Torres, KymHeming, RobHenry, ElizabethHoser, Philip & TessaHough, KimbleHyer, RoseIT Project Management ConsultantsJones, Douglas NKallidakis, G & DKapaniris, FiliaKappatos, VKatsaros, DimitraKearney, BernardKerr, LindaKing, GKing, RobertKirk, SueKirkman, PatrickKoranteng, Eric AnsahKrynen, VanessaKumar, HarishLazarus, JayLew, Yean MuiLin, LanceLinn, WinnieLivingston, ClydeLivingstone, J DLyne, Jacqueline AMa, CharlesMarks, Greg & AnneMavin, Dean RMay, LornaMcDermott, HollyMcFayden, G&SMedimurac, DavidMerrett, H PMoyle, SallyMuston, AJNader, MNeads, RosemaryNewton, ANightingale, StefanNolan, AliceO'Brien, Andrew & JaneO'Connor, RM & CAO'Connor, SO'Rourke, PeterPatterson, R & JPavlis, Chris & BettyPearson E & GPearson, John & TraceyPham, Khien DinhPickette, SarahPiesse, KPrathvangsin, MakhaRenehan, AlecRider & Chung, N & ARobinson, JudyRodwell, SteveRoychoudhry, AnilScandol, DavidSchelks, Kerry AnnSchembri, John

Sciberras, MariaScouller, P A & L IScrivener, AndrewShopov, John & TinaSimpsonSinclaire, NicoleSmith, Louise & PaulSpence, AmandaSpooner, Lorraine & JamesSt Catherine's SchoolStibilj, SueStokes, H T & AStratton, C JTalbot, LyndaTasic, TatjanaTiberti, NellaTruman, ClareTurner, GrantVallis, PamVan Gorp, SeanVan WelVeitch & Burton, S & JVolkofsky, TanyaWallis, MarkWaples, KWatson, Ken & PatWeir, Josephine Wicks, MaryWright, DWu, Bao XinYoroot, Orasa

DONORS $50 - $99Adams, S A & K MAkai-Dodds, KevinAnderson, KatrinaAthanassopoulos, NitsaAustralian Stock ExchangeBaker, ClareBaker, LawrenceBassett, DamonBenger, DeniseBoye, KBozic, ZdenkaBrian-Patterson, MonicaBridge, DamianBrown, B MBusuttil, KristyCaines, A & JCarnemolla, J & LCarter, R & CChae, Su JeongChatfield, MargaretChilbey, GrahamChiotellis, GeorgeChristodoulakis, A KChu, Mei YeeClancey, Dave & AmandaClark, Richard FCooper, PeterDenyer, GDixon, David VDowie, LeanneDriscoll, GEaton, David WEdgoose, EthelEdmonds, S L & S L

Fitzgerald, B G & P EFreeman, StephenGrant, B J & R JGrant, Darren & JaneHall Lisa AnnHeath, CarolHepton, A & MHerbert, BrianHirachan, AnubhutiHyde, MichelleJohnson, DavidJones, AndrewKallegeros, PeterKeen, PeterKentishKimble, R LKollias, ElectraKumar, SandeepLamble, H BLilley, LorraineLisle, H & SLong, JenniferLovell, John & KathyLykissas, Kim & AlisonMackay, JeffMagarey, AMaratos, ChristineMarks, KenMcanulty, SharonMcLachlan, LindaMcLoughlin, MartinMercer, ScottMhamar, MargaretMoore, ShelleyMorpurgo, DNesbitt-Hawes, CNguyen, Truc Thi ThanhOgle, SOrtil-Tullo, A & LPele, APerera, Surane APham, BinhReid, NaomeRitchie, Shirley & KimRobertson, ScottRowe, TraceySchmolzer, CarolineSeverino, BrunoSevill, Cara DSharman, D & GSmith, MichaelSpanswick, R JSpencer, L & ASpiteri, ConnieSt Pierre, B & SStee, T & MStewart, D ISuwannakudt, PhaptawanSuwardi, HenyTemby, DianaThit, MyaThompson, BernadetteUemura, MarikoVlahos, SVolpini, ValerieWeir, ToniWilliamson, TonyYang, SeungwonZhang, Qiong

Nick Evans (R) with Sargents representatives

David Osborn (R) with McDonalds representatives

“Clowning Around”

RPA NEWBORN CARE