The Impact Of Developmental Haemostasis On The Pharmacokinetics And Pharmacodynamics Of Heparin In Children.
Funder
National Health and Medical Research Council
Funding Amount
$283,676.00
Summary
Unfractionated Heparin (UFH) is the most commonly used anticoagulant (blood thinning drug) in children. Despite this, the clinical evidence, in terms of reported treatment failures and bleeding complications, suggests the drug is used suboptimally in children compared to adults.This likely relfects the lack of specific studies of UFH in children. This study will, for the first time, define the pharmacokinetics-dynamics of UFH in children, allowing age-specific protocols to be developed. Pharmaco ....Unfractionated Heparin (UFH) is the most commonly used anticoagulant (blood thinning drug) in children. Despite this, the clinical evidence, in terms of reported treatment failures and bleeding complications, suggests the drug is used suboptimally in children compared to adults.This likely relfects the lack of specific studies of UFH in children. This study will, for the first time, define the pharmacokinetics-dynamics of UFH in children, allowing age-specific protocols to be developed. Pharmacological modelling of this data will likely have implications for the use of other anticoagulants in children.Read moreRead less
Parent Initiated Oral Prednisolone For Acute Asthma In Children Aged 5-11 Years: Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$139,250.00
Summary
The objective of this trial is to determine whether parents should commence prednisolone (a steroid anti-inflammatory drug) for an asthma attack in their child without waiting to see a doctor first. This strategy could be described as parent initiated prednisolone in asthma (PIPA). PIPA is an important consideration in every child's asthma management plan, but because of a lack of research evidence the role of PIPA is not clarified in any of the international asthma guidelines. Hence prednisolon ....The objective of this trial is to determine whether parents should commence prednisolone (a steroid anti-inflammatory drug) for an asthma attack in their child without waiting to see a doctor first. This strategy could be described as parent initiated prednisolone in asthma (PIPA). PIPA is an important consideration in every child's asthma management plan, but because of a lack of research evidence the role of PIPA is not clarified in any of the international asthma guidelines. Hence prednisolone is rarely commenced without waiting for a preceding medical review. PIPA has the potential to significantly reduce the health and economic burden of the disease by increasing the proportion of asthma exacerbations managed at home rather than in the emergency department or hospital. Prednisolone has been shown to be an effective drug when it is given to children with an asthma attack that is severe enough for them to attend hospital. Whilst it would seem logical that PIPA should be an effective strategy it is important to recognise that mild attacks are far more common than severe ones, and the promotion of PIPA as standard practice would be associated with a significant increase in the frequency prednisolone administration. As such it is important to determine if prednisolone is safe and effective when commenced in the home setting. The PIPA trial has many unique features: It is community based, where the vast majority of asthmatic children are managed. The eligibility criteria and dosing schedule have been chosen to mimic 'real world' management and it will be easy for clinicians and families to interpret and apply the results. A very large number of children will be involved (308) which has been made feasible by the trial setting and recruitment methods. Furthermore the protocol has been designed in accordance with the highest standards specified by the international research community and has been submitted to 'The Lancet' for pre-trial publication.Read moreRead less
A Study To Determine The Effects Of Heparin/ Low Molecular Weight Heparin In Neonates And Children.
Funder
National Health and Medical Research Council
Funding Amount
$193,000.00
Summary
Blood clots in newborns and children are becoming a more common problem. This is because many children with major illnesses are now surviving due to the remarkable advances in medical and surgical care. Blood clots in children can have devastating long term effects. Little is known about the best way to treat blood clots in children and most treatments are just extrapolated from adult treatment guidelines. This is unlikely to be the best treatment as the type and place of blood clots in children ....Blood clots in newborns and children are becoming a more common problem. This is because many children with major illnesses are now surviving due to the remarkable advances in medical and surgical care. Blood clots in children can have devastating long term effects. Little is known about the best way to treat blood clots in children and most treatments are just extrapolated from adult treatment guidelines. This is unlikely to be the best treatment as the type and place of blood clots in children are very different to adults. In addition, the blood clotting system in children is very different to that in adults. This is especially true for newborns. Over the last four years we have established the largest clinical treatment program for children with blood clots in Australia, and have completed the preliminary work that will enable us to now study a number of aspects of the treatment for blood clots in children. This project will specifically examine heparin and low molecular weight heparin which are the most commonly used antithrombotic (anti blood clot) drugs in children. We will determine the effect of age on the mechanism of action, the optimal drug level for treatment, the frequency of the most common side effect of heparin and do some preliminary work to determine alternative treatment options. Our study will provide the basis for more appropriate use of these drugs in children, which will improve the success of therapy and reduce the risk of complications, ultimately improving the survival and quality of life for sick children affected by blood clots.Read moreRead less
Prediction Of Microvascular Complications In Type 1 Diabetes Using Novel Retinal Vascular Imaging Techniques
Funder
National Health and Medical Research Council
Funding Amount
$396,818.00
Summary
Children with type 1 diabetes face the risk of developing severe complications later in life involving their eyes (retinopathy), kidneys (nephropathy) and nerves (neuropathy). This study aims to determine if subtle, early changes seen in the retinal blood vessels, as measured from new computer imaging techniques, predict the subsequent development of these diabetes complications in children-adolescents with type 1 diabetes.
Effects Of Upper Versus Lower Respiratory Infections On The Induction Of Atopic Asthma.
Funder
National Health and Medical Research Council
Funding Amount
$386,483.00
Summary
Asthma is more common now in developed countries than it was 20-30 years ago. Many fewer children have asthma in developing countries and there does not appear to have been the same increase in asthma in recent years. Children in developed countries tend to have fewer respiratory infections and recent studies suggest that this may be partly responsible for the increase in asthma. An understanding of why asthma has increased in developed countries may lead to strategies to prevent asthma. In orde ....Asthma is more common now in developed countries than it was 20-30 years ago. Many fewer children have asthma in developing countries and there does not appear to have been the same increase in asthma in recent years. Children in developed countries tend to have fewer respiratory infections and recent studies suggest that this may be partly responsible for the increase in asthma. An understanding of why asthma has increased in developed countries may lead to strategies to prevent asthma. In order to understand the role that respiratory infections may play in the induction of asthma, it is necessary to study babies from birth, documenting each respiratory inflection and monitoring their diet. In a recent large study we have shown that parental reports of common colds and chest infections do influence how many children have asthma at age 6. Also in this study, breast feeding for at least 4 months seemed to be protective against developing asthma. However, we were not able to verify how many infections the children in that study actually had. We are currently studying a population of 236 infants, all of whom are at high risk of developing asthma and allergies. At the end on November 1998, 163 of these infants had reached one year of age. During the first year of life, these infants had a total of 669 respiratory infections, with individual babies having between 0 and 11 infections. We now plan to monitor these children until they turn 5, when we will determine how many have asthma and allergies. In this way we will be able to determine whether children who have more respiratory infections early in life are more or less likely to have asthma and allergies at 5 years of age. We will also be able to tell whether breast-feeding is able to decrease the chance of developing asthma and allergies.Read moreRead less
A Prospective Randomised Trial Comparing Nasogastric With Intravenous Hydration In Children With Bronchiolitis
Funder
National Health and Medical Research Council
Funding Amount
$886,817.00
Summary
This project aims to compare the two methods currently being used of providing fluid to young children who have a viral infection of the lungs called bronchiolitis. The methods of giving fluids are through a tube placed though the nose, down the food pipe, into the stomach (nasogastric tube), or through a drip in the child's vein (intravenous). We hope to show that one of these methods is better than the other and allows children to be sent home from hospital earlier, and cost less.
Amoxycillin For Persistent Nasal Discharge In Rural And Remote Aboriginal Children: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$226,738.00
Summary
Aboriginal children have the highest rates of acute and chronic respiratory diseases ever documented. While the underlying cause is socioeconomic disadvantage, the features of poverty that result in disease are not clear. Our current understanding of important risk factors like overcrowding, malnutrition and smoke exposure cannot completely explain the excessively high rates of disease seen in rural and remote Aboriginal communities. This randomised, double-blind, placebo-controlled clinical tri ....Aboriginal children have the highest rates of acute and chronic respiratory diseases ever documented. While the underlying cause is socioeconomic disadvantage, the features of poverty that result in disease are not clear. Our current understanding of important risk factors like overcrowding, malnutrition and smoke exposure cannot completely explain the excessively high rates of disease seen in rural and remote Aboriginal communities. This randomised, double-blind, placebo-controlled clinical trial will measure the impact of antibiotic treatment on persistent nasal discharge and rates of transmission of bacterial respiratory pathogens. An innovative study design will test the efficacy of twice daily doses of amoxycillin on newly developed clinical and bacteriological outcome measures. Both the investigators and the Aboriginal community have considerable experience in conducting this type of research and are committed to using a cooperative model of clinical research to reduce disease burden. Ongoing training of Aboriginal health workers in the principles of clinical epidemiology is an essential component of this process. This study will make an important contribution to the medical literature. Despite the deaths of around 10,000 children children from acute respiratory infections each day, very little is known about how antibiotics affect the transmission of some of the principal causative organisms. This project will greatly assist the development of appropriate antibiotic prescribing practices in high-risk populations.Read moreRead less
Long Term Outcome From Early Childhood Brain Injury: 10 Year Follow Up
Funder
National Health and Medical Research Council
Funding Amount
$338,900.00
Summary
The primary aim of this project is to further improve our understanding of the long-term consequences of childhood traumatic brain injury (TBI). Over the past decade our research team has ascertained a sample of children sustaining TBI, and systematically followed their progress over a 5-year period. The project has an international reputation, and is unique in terms of length of follow-up, prospective design and representative, well-maintained sample. Our findings challenge the traditionally he ....The primary aim of this project is to further improve our understanding of the long-term consequences of childhood traumatic brain injury (TBI). Over the past decade our research team has ascertained a sample of children sustaining TBI, and systematically followed their progress over a 5-year period. The project has an international reputation, and is unique in terms of length of follow-up, prospective design and representative, well-maintained sample. Our findings challenge the traditionally held view that children are resilient and recover fully from early brain insult. Rather, we have shown that, up to 5 years post-TBI, many children experience impairments in physical, cognitive and behavioural function. These impairments result in educational, vocational, social and emotional problems, limiting the child's capacity to meet developmental expectations and achieve adequate quality of life. The implication is that these problems will lead to life-long disability, resulting in high levels of individual, family and community burden. However, with follow-up data limited to 5 years, there remains a possibility that ongoing developmental processes may support an extended recovery period in childhood TBI, in comparison to the 2-year period cited in adult models. The review of this sample, 10 years post-injury, provides an unprecedented opportunity to address this possibility and to document recovery-outcome as children move into adolescence and adulthood. Not all children experience problems post-injury. However, predicting individual outcome remains a significant challenge, with particular clinical relevance to treatment and follow-up. Thus, the second aim of the proposed study is to examine factors that contribute to recovery and outcome.Read moreRead less