Some of New Zealand's most vulnerable premature babies will soon take part in ground-breaking research aimed at improving their health and those of other pre-term infants worldwide.
The research, a collaboration between Auckland City Hospital and the University of Auckland, will investigate use of a computer model to adjust the insulin dose in pre-term babies with high blood-sugar levels, seek ways of reducing lung injury, and investigate whether increased protein will improve growth and development.
It follows on from pioneering research in the 1970s by Auckland medical scientist Professor Sir Graham Liggins and paediatrician Dr Ross Howie, who showed that giving steroids to women in early labour could accelerate infant lung development enough to enable premature newborn babies to breathe unaided.
Jane Alsweiler, a senior lecturer in the department of paediatrics at the university, said more research was needed to improve long-term outcomes for the tiny babies.
"We're now in the situation where we've got a lot more of these babies surviving, but they're still at risk of having problems with how they develop with their brain or their eyesight or their lungs, so we want to do more research to improve their outcomes long-term."
Dr Alsweiler, who's also a neonatal pediatrician at Auckland City Hospital, is principal investigator on a project aimed at preventing brain injury in extreme pre-term babies.
These tiny infants, some weighing less than 1kg, commonly develop high blood-sugar levels or hyperglycaemia after they are born, which is often associated with brain damage.
Hyperglycaemia is usually treated with insulin, but in very small babies the insulin requirements can fluctuate over a short period of time, which makes the correct dose of insulin difficult to determine.
"So a side-effect of that is the blood-sugar levels can go too low, which has been associated with poorer brain development."
A University of Canterbury computer program which determines each dose will be trialled on 138 very pre-term babies to determine if it is a better method for reducing the incidence of hypoglycaemia.
The second project, which is in progress, is a trial aimed at reducing lung injury in pre-term babies.
When babies are born extremely pre-term, mechanical ventilation is often necessary to assist their breathing and aid survival, but it can also contribute to ventilator-induced lunginjury.
"The sad thing with ventilators is that even though they are necessary for the baby to breathe, they do damage the lungs," Dr Alsweiler said.
"So we try to get them off a ventilator as soon as possible and we're trying to find ways to ventilate them that aren't as damaging to the lungs."
The third study will boost protein in extremely low-weight babies in the first week after birth to try to improve brain development.
The three neonatal research projects have been given funding by Cure Kids in its latest grants round.
"We select five studies, and each are funded for approximately $100,000," Cure Kids marketing general manager Tessa Tierney said.
"Research has helped improve the survival rates for these babies but there is still so much left to know."
Tiny triplets helping in ventilator trial
When Lucy and Steven Nicoll discovered they were having triplets, the Muriwai couple knew Mrs Nicoll would have trouble carrying the babies to term.
Triplets are usually born at 33 weeks gestation, but because of an operation which shortened Mrs Nicoll's cervix when she was 19, she had delivered the couple's first son Harry five weeks premature.
At 19 weeks into her pregnancy with the triplets, Mrs Nicoll, 24, had surgery to keep the babies in her womb to at least the 24-week mark.
The part-time accountant went on bed rest but Molly, Joshua and Cameron were determined to arrive at 25 weeks, last Sunday. The three tiny babies were put in incubators on ventilators.
A week on and Molly, who was the heaviest at 795g, or the equivalent of about a block and a half of butter, is now only partly ventilated while Joshua (740g) and Cameron (720g) are still fully ventilated.
The Nicolls, both from Britain and with no family in Auckland, immediately agreed to let their babies participate in the ventilator study aimed at reducing lung injury in extremely pre-term infants.
"We gave consent straight away because we'd like to help out as much as we can because this place is amazing," Mrs Nicoll said.
She said she and her husband made sure the triplets would not be negatively affected by the trial before signing them up.
"You enjoy this amazing care for your children and the only reason it's got this good is through studies, so if we can be part of something like that and help out in a small way, then that's good."
The Nicolls will soon be able to hold their babies for the first time after brain scans ruled out cerebral palsy.
• 780 very pre-term babies - born at less than 32 weeks - are estimated to be born in New Zealand every year.
• 250 babies are estimated to be born extremely pre-term (28 weeks gestation or earlier and weighing 1kg or less).
• Challenges these babies face in early childhood include increased rates of hospitalisation, respiratory problems, poor growth, physical problems, learning and behavioural difficulties.