Location: Perth, WA. Conferences Dates: 6 9 April Scholar/Alumni Conference Page

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1 Perinatal Society of Australia and New Zealand (PSANZ) 17 th Annual Congress Location: Perth, WA Conferences Dates: 6 9 April 2014 Scholar/Alumni Conference Page Hannah Dalrymple Perinatal Society of Australia and New Zealand (PSANZ) 17th Annual Congress 2 4 Grace Butel-Simoes Perinatal Society of Australia and New Zealand (PSANZ) 17th Annual Congress 5 7 Reports submitted by RAMUS scholars and Alumni who attended this conference with support from the RAMUS 1

2 Hannah Dalrymple I was fortunate to be able to attend the Perinatal Society of Australia and New Zealand s annual conference on 6-9 April 2014 due to funding provided through the RAMUS. The conference theme was Networking: The New Frontier and there were combined activities with the Developmental Origins of Disease and Health conference, which took place on 9-10 April. Unfortunately due to work commitments I was unable to attend the full DoHAD conference but the combined plenary was fascinating. The conference took place at Crown Casino Convention Centre in Perth, WA, and was a perfect opportunity for networking with colleagues from across Australia who work in the field of neonatology including midwives, neonatal nurses, neonatologists and obstetricians. Due to the location in WA there was a focus on improving perinatal Indigenous health with a plenary dedicated to this. There were discussions around the benefits to Indigenous patients in a tertiary setting through implementing indigenous health care workers in a tertiary setting in Perth, and also discussions regarding intervention in a Kimberley community using a method of involving the local women to improve the health outcomes of children and young mothers. It was inspiring to hear the results that have been achieved in just one community with wide reaching education developed by the women in the form of videos that are now distributed across communities. There were a multitude of sessions to be attended each day including plenary, symposium, special interest group meetings, paper and poster presentations, and evening symposium. Some of the more interesting and relevant presentations I attended are discussed below. I attended the Inaugural Special Interest Group Meeting for Foetal Therapy on Sunday 6 April prior to the start of the conference. Some very interesting knowledge was discussed in this session including the new recommendations for antenatal Congenital Adrenal Hypoplasia therapy which are to perform non-invasive diagnostic testing for gender at five weeks gestation, followed by for diagnosis at six weeks in females. This is to avoid giving the seven eighths of pregnancies that are unaffected high dose dexamethasone (with risk of low birth weight, cleft palate, increased gender Reports submitted by RAMUS scholars and Alumni who attended this conference with support from the RAMUS 2

3 neutral behaviour in boys and impaired working memory) and to initiate treatment early enough to prevent the need for corrective surgery later in life. Another interesting presentation was regarding an association of preterm birth with Mannose Binding Lectin deficiency, which should be suspected in those mothers with preterm birth who have severe sepsis with few symptoms or an unusual pattern of sepsis. Importantly treatment with FFP (fresh frozen plasma) has allowed these women to progress to full term births. One paper looked at the issue of cooling for perinatal hypoxia and examined the difference between effectiveness of cooling babies performed by referring hospitals (non-tertiary metropolitan and rural/remote) versus cooling initiated by the newborn emergency transport service (NETS) at retrieval. It found that passive cooling initiated by the referring hospital was more likely to achieve the desired temperature but was also more likely to cool the infants to less than 33 degrees compared to NETS initiated cooling. When cooling was initiated by the referring hospital it was started earlier and the temperature was achieved earlier and, given there is evidence that earlier cooling provides better neuroprotection, it is important for referring hospitals to initiate cooling while waiting for retrieval. I attended a breakfast meeting Rational Approach to prescribing in NICU and the important points were that penicillin or ampicillin with gentamicin are the most appropriate initial therapy for neonates across Australia. Cefotaxime should be added if gram negative sepsis suspected, especially if no organisms seen on microscopy in a septic baby. Serial low C-reactive protein (CRP) can be a guide to cease antibiotics. There is minimal data on intra-muscular injection absorption in preterm babies so it should be avoided. Acyclovir should be used if isolated high white cell count in cerebrospinal fluid or for isolated skin lesions, especially if located on the scalp. Importantly a proportion of babies with meningitis have negative blood cultures, especially in late onset sepsis so all babies need a lumbar puncture if sepsis is suspected. A symposium on nutrition and lactation was relevant to care of neonates and children across Australia and highlighted that first feeds should be iron rich (eg fortified cereals, pureed meat), particularly in Indigenous communities. Egg and gluten should be introduced at less than six months of age whilst still breastfeeding to minimise risk of allergy. And most importantly it was found in a Reports submitted by RAMUS scholars and Alumni who attended this conference with support from the RAMUS 3

4 retrospective Queensland study that 56 per cent of women cease breastfeeding due to poor supply. Given that less than five per cent of women have inadequate supply to provide nutrition for their child it is vital that women are counselled appropriately regarding importance of breastfeeding, and appropriate rates of weight gain. Attendance at the PSANZ conference provided me not only with knowledge relevant to my career by also an opportunity to network with new and old colleagues in a part of Australia that is similar to where I work, but also very different in the needs of its community. It has inspired me to become more involved in research and hopefully in the future to be more involved with care of neonates and their families from rural and remote Australia, through the tertiary setting, retrieval medicine and also provision of care in rural areas. This was a very valuable experience, which I am very thankful to RAMUS for giving me the opportunity to attend and share my updated knowledge. Reports submitted by RAMUS scholars and Alumni who attended this conference with support from the RAMUS 4

5 Grace Butel-Simoes The PSANZ (Perinatal Society of Australian and New Zealand) conference was held on 7-9 April at the beautiful Crowne Convention Centre on the banks of the river in Perth. The conference showcased amazing research, clinical work and reviews of current practice which were both insightful and inspiring. The first plenary was a fantastic way to open the conference with the topic focusing on improving perinatal Indigenous health. Among the many prestigious speakers was Karen Edmond who spoke on Models to improve primary care for young Aboriginal infants. Professor Edmond s presentation focused on improvement of health and health outcomes amongst ATSI children through deliverance of health services. She gave personal details of her experience working with Aboriginal communities and her collaboration with other services, speaking fondly of the rewards and sense of fulfilment it brings and the positive impact that her work has on the community. She stressed the importance of the need to achieve the Closing the Gap target for antenatal care. The entire panel of speakers was remarkable and the discussion points about creating successful programs that engage Aboriginal communities and are sustained beyond the limits of projects and initiatives was a key message throughout. There was much discussion about serving and establishing health services in remote regions where fly-in-fly out projects operate. The need for continuity of workers, investing time to form relationships with the community and being alert and proactive in adopting suggestions from the community about the way things would best work to fulfil the objective of health workers whilst engaging the community were discussed. Ensuring sustainability beyond the time constraints of the program was a key discussion point. The placenta and ultrasound short presentations were informative about a range of conditions I was unfamiliar with such as TTTS. One particular study evaluating the accuracy of ultrasound prediction of birth weight found that beyond two weeks pre-delivery ultrasound was in fact quit unreliable. This has application both to clinical practice and to the use of ultrasound in the research arena. The Reports submitted by RAMUS scholars and Alumni who attended this conference with support from the RAMUS 5

6 study also proved the supremacy of certain methods of ultrasound calculations of birth weight over others. The second day of the conference proved to be just as interesting, beginning with a plenary on inflammation and immunology. The CNS insults and Neuroprotection special interest talk was a standout group of presentations. I was fascinated, inspired and intrigued by the research into preventing hypoxic asphyxiation in neonates which can lead to long term neurological consequences such as cerebral palsy. The work being carried out by the Ritchie Centre linked with Monash University exploring the use of melatonin in addition to hypothermia to improve outcomes was promising. Their data demonstrated a reduction in morbidity and mortality when these two therapies were used in combination. Whilst some of their data was preliminary it was exciting to get a sneak peak at what might change in clinical practice in the future. The symposium on perinatal stress and mental health brought into focus the marked differences and inequality with increasing rurality and poorer mental health. The research and clinical data presented showed some strong evidence for poorer neonatal outcomes, attachment and development the more rural the mother was living. A special focus was placed on schizophrenic patients and ensuring good control of their condition to prevent episodes of instability which are correlated with high stress, premature birth and low birth weight. The complex factor in assessing the effect of mental health on neonates and foetus is the variable contribution of environmental factors. The particularly poor outcomes and the higher burden of mental illness amongst Aboriginal and Torres Strait Islander women were also discussed with mention of a current study involving the Ieramagardu people of West Pilbara exploring the extent of mental health issues, providing antenatal support and recording outcomes. The project has been received well by the community, with rapport developing and skills for sustaining the success being taught to the Aboriginal leaders and healthcare workers in the community. I thoroughly enjoyed hearing about projects such as this which were beneficial for research and simultaneously actively improving the health of communities. Reports submitted by RAMUS scholars and Alumni who attended this conference with support from the RAMUS 6

7 The final day plenary Developmental Origins of Health and Disease (DOHaD) largely focused on preventative medicine and the ability to affect positively later life health through early neonatal growth and development. Professor Atul Singhal s presentation on The role of early life factors in the global epidemic of NCD highlighted the known links between early life obesity and morbidity later in life. He discussed the role of environmental factors and genes which also influence development and health alongside preventable risk factors, demonstrating how practitioner advice and guidance can influence positively the health of future generations. The formal sessions where complemented by insightful conversations I had with doctors and researchers in the field during morning tea and lunch sessions. I enjoyed hearing about their work and achievements. My goals for attending this conference were to learn more and be inspired by a potential career trajectory I am considering as well as to network with other health professionals to learn more about the speciality area and their work. The PSANZ conference certainly exceeding expectations in exposing me to the exciting research and most current practice in perinatal care. I thoroughly enjoyed the opportunity to engage professionally through this well organised forum and in such a beautiful city. Observing excellent presenters, the techniques they use to engage the audience, the effectiveness of their media support and the professionalism they displayed, set the standards for what I hope to meet in the future. Reports submitted by RAMUS scholars and Alumni who attended this conference with support from the RAMUS 7