Monday, 24 April 2017

Dangerous dreams: new Monash research reveals the health consequences of children's snoring

Professor Rosemary Horne
Up to 30 per cent of children snore, with pre-schoolers more likely to be affected than older children. Approximately five per cent of children will suffer from obstructive sleep apnoea (OSA), when the airways briefly collapse during sleep, blood oxygen levels fall and sleep is disrupted. Most Australian parents believe their child’s snoring is harmless and something they will grow out of. 

New research from Monash University – that will continue to be undertaken at the newly opened MonashChildren’s Hospital - reveals this snoring is not harmless but may have long term cardiovascular, neurocognitive and behavioural implications.

Monash Professor Rosemary Horne and her team studied 136 children aged 7-12 years and 128 children aged 3-5 years to examine the consequences of snoring and OSA. Children were then followed up three to four years later to examine the effects of treatment or resolution of symptoms.

The team found that pre-school children who snore had normal blood pressure and neurocognitive development but had increased reports of poor behaviour. The older, school aged children (7-12 years) had:

·         Increased blood pressure of 10-15 mmHg
·         Increased reports of poor behaviour
·         Reduced intellectual ability

When they were followed up, any improvement in severity of snoring or OSA was associated with improvements in blood pressure and behaviour but not cognitive function. According to Professor Horne, the findings that consequences are more severe in older children indicate that the long term effects of snoring are cumulative, impacting on the child’s cardiovascular health, as well as on long term behaviour, learning and cognitive development.

Previous studies have shown that oxygen concentration in the blood (measured with a sensor on the finger) is the same between the snoring children and those that didn’t snore – suggesting that low oxygen is either not the explanation for the findings or the current methods of measuring this may not be sensitive enough.

Professor Horne is currently using MRI scans and direct non-invasive measurements of oxygen levels in the brain to determine whether there are more subtle effects of oxygen deprivation happening in the brains of children who snore, affecting blood pressure and behaviour.

Professor Horne said the most common cause of childhood snoring is enlarged tonsils and adenoids. More than 50,000 Australian children have a tonsillectomy and/or an adenoidectomy each year, many of which are for sleep apnoea. 

“Our results indicate that snoring and sleep apnoea have important implications for children’s health and parents should consider getting medical advice about the need for surgery,” Professor Horne said.

The MRI study, led by Professor Horne, will continue in the Melbourne Children’s Sleep Centre in the new Monash Children’s Hospital.



Early clues from placenta may predict future life threatening lung problems in premature infants

Professor Arvind Sehgal
New research from Monash University’s Professor of Pediatrics, Arvind Sehgal has provided early clues from the placenta, which may indicate which infants among this high risk cohort might go on to develop BPD associated PH during the weeks or months following birth. This opens avenues for individualized ventilator management, watching out for early signs of this complication, early echocardiographic diagnosis and therapy to improve lung function.

Each year in Australia, approximately 500 infants are born at less than 25 weeks gestation. These infants are very premature and experience a number of life-threatening issues.

More than one third of these babies develop bronchopulmonary dysplasia (BPD) - also known as chronic lung disease -combined with chronic pulmonary hypertension (PH), or high blood pressure, in the lungs. These infants experience long and repeated hospitalisations, requiring home oxygen for up to two years and an increased risk of mortality because of a vulnerability to infection.

Professor Sehgal and his research team, including pathologist Dr Yuen Chan, tested the placentas of 56 mothers of very preterm babies (<28 weeks gestation) and noted peculiar histopathology markers which predicted ‘subsequent’ complications of BPD associated PH. These findings will be presented at the prestigious Society for Pediatric Research Annual Meeting, being held in San Francisco, USA in May 2017.

“The ability to predict which infants may become very sick will provide critical information for doctors managing these premature infants,” Professor Sehgal said.


Professor Sehgal’s research group is the first in Australasia to demonstrate that the placenta contains a treasure trove of relevant information which can be used to improve the outlook for these premature infants.

Australian military doctors and scientists recognised in latest book

Associate Professor Geoff Quail
In his recent book, former Monash University lecturer and surgeon Associate Professor Geoff Quail reveals how past Australian military mistakes led to devastating health consequences for personnel.

Published last month, Lessons Learned: The Australian Military and Tropical Medicine recognises the Army’s Tropical Disease Research units and the efforts of individuals in helping the military succeed in battle.

Associate Professor Quail said he was compelled to write the booked as there had been no comprehensive assessment of the very substantial contribution of the Australian Army doctors and scientists since the inception of the Australian Army Medical Corps in 1901.

“Historically, prolonged campaigns have frequently been won or lost because of greater fitness of one of the combatant armies,” said Associate Professor Quail.

“In the twentieth century, infection was still a major problem contributing substantially to the necessity of withdrawal from Gallipoli and the near defeat of the Allies due to malaria in the Second World War's Pacific campaign.  Malaria emerged again as a major problem in the Vietnam War.” 

Associate Professor Quail said we ignore the past at our peril. 

“In hindsight it is difficult to understand why past failures were disregarded when it was known that health of the contingent is pivotal to success in the field.”

“The Australian Army Medical Corps learned from past medical experience, however, errors leading to significant morbidity did occur mainly in relation to malaria, in particular inadequate prophylactic measures, early in the New Guinea campaign of World War Two.”

“The failure to perceive the threat of emerging resistant strains of malaria in the 1960s and military commanders not fully implementing the recommendations of their medical advisers were other mistakes.”

Many Australian military campaigns and deployments have taken place in the tropics where infection is still a major concern. 

“It is not well known that Australian military doctors and scientists have made, and continue to make through the Australian Malaria Institute, a substantial contribution to tropical medicine,” said Associate Professor Quail. 

“Their work extends well beyond the requirements of the military, greatly improving health outcomes for people residing in the tropics.”

Two institutions, the Land Headquarters Medical Research Unit led by Brigadier Hamilton Fairley in World War Two and the today's Army Malaria Institute in Townsville have world-wide reputations for the quality of their research.

Associate Professor Quail’s book recognises the efforts and details the scientific work of both individuals and the Australian Army's Tropical Research units in protecting the health of Army personnel whilst on deployment and the potential benefits of its finding for all people in the tropics.


Monash visit to Vietnam opens research collaboration opportunities

Professor Liem Nguyen, Professor Graham Jenkin
with delegates 
Last week, Professor Graham Jenkin, Department of Obstetrics and Gynaecology, was the guest of honour and Plenary Speaker at the Vinmec inaugural "Workshop on application of stem cell and gene technology in cerebral palsy and severe diseases diagnosis and treatment" held in Nhin Binh, Vietnam.

Professor Jenkin was hosted by Professor Nguyen Thanh Liem, Director of the Vinmec Research Institute of Stem Cell and Gene Technology at Vinmec International Hospital in Hanoi. Vinmec is the Hospital arm of the VinGroup, comprising six major hospitals in Vietnam and voted by the Hospital Management Association of Asia as Vietnam's most progressive hospital. 

The Flagship hospital is located in Vinmec Times City in Hanoi, which also houses their state of the art research laboratories. 

"These laboratories include the Stem Cell and Gene Technology Centre and the Vinmec Assisted Reproductive Technologies Centre," Professor Jenkin said. 

"Professor Nguyen, the Director, already has a long term collaboration with Associate Professor Chris Kimber, Head of Paediatric Surgery at Monash Children's Hospital."

As a result of a visit to the Monash Health Translation Precinct (MHTP) in December last year, Professor Nguyen and Professor Jenkin recognised there was significant potential for interaction and collaboration between the two Centres, as well as with the recently opened Monash Children’s Hospital.

Around 80 Vinmec staff and research professionals attended Professor Jenkin's presentations, which included an overview of the MHTP Translational Research Facility and talks about the research being undertaken by the Cell Therapy and Regenerative Medicine Group, headed by Professor Jenkin, and the Fetal and Neonatal Health Neuroprotection Group, headed by Associate Professor Suzie Miller.

"The Vinmec Institute presented on their clinical translation research and trials on use of stem cells in the treatment of cerebral palsy, broncho pulmonary displasia, autism and liver fibrosis after biliary atrophy surgery; as well as on gene mutations in autistic children and gene therapy for RETT syndrome," Professor Jenkin said.

Professor Nguyen will pay a reciprocal visit to the MHTP in November this year. Anyone interested in meeting with Professor Nguyen should contact Professor Graham Jenkin.

Congratulations Steven Cho on the award of his PhD

Congratulations Steven Chin on the award of his PhD this month.   
            
Steven’s thesis expanded on unravelling the complex immune pathways that are involved in the pathogenesis of necrotising enterocolitis, and addressed an urgent unmet need by identifying interleukin-37 as a potential therapeutic agent.

Steven thanks The Ritchie Centre for providing support and opportunities such as PSANZ to showcase his research, as well as staff at the animal house for accommodating the odd requests needed for his project.

Pint of Science coming to Melbourne 15-17 May, 2017

Pint of Science delivers interesting and relevant talks on the latest science research in an accessible format to the public – all in the pub! Pint of Science is a platform which allows people to discuss research with the people who carry it out - no prior knowledge of the subject is required. It is run mainly by volunteers and was established by a community of postgraduate and postdoctoral researchers in 2012 in the UK. The main festival takes place annually over three days in the month of May simultaneously in pubs across the world.

On 16 May, our very own Dr Connie Wong will talk about her research into stroke and infections.

More information here: pintofscience.com and book tickets for events in Melbourne here: https://pintofscience.com.au/events/melbourne

Monash Health International Clinical Trials Day, 18 May